NCG060351_MONITORING INFO_20190320

NORTH CAROLINA
r�
Department of Environmental Qua

mf/t)
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ �lV �'7 lD 3
YYYYMMDD

I
ARNENVIRONMENTAL
SERVICES, INC.
ASSESSMENT a REMEDIAL SERVICES DIVISION RECEIVED
March 13, 2019 MAR 2 0 2019
JQsevt fkz",,p CENTRAL, FILES
Mann -Hummel Filtration Technology DWR SECTION
1551 Mount Olive Church Road
Gastonia, NC 28052
RE: Tier If Monthly Stormwater Report - North Carolina General Permit No. NCGO60000
Certificate of Coverage Number NCGO60351
February 2019 Tier 11 Report
Stormwater Permittee - "Wix Corporation" - Mann- Hummel Master Distribution Center
1551 Mount alive Church Road, Gastonia, NC 28052
ARM Project No. 12-4028-14
Dear Ms. Funderburk:
Based on the second exceedances of total suspended solids (TSS) and chemical oxygen demand (COD)
in Outfall 2 during the second semi-annual stormwater sampling event in December 2017 and in
accordance with the North Carolina Department of Environment, and Natural Resources (NC DENR)
stormwater discharge permit Tier II sampling requirements, ARM is providing this report as the ninth Tier
It sampling report of Outfall 2. During the month of February 2019, a sample was collected from Outfall 2
and analyzed for TSS, COD, and oil and grease. The analytical results are shown in the Table below.
The COD exceeded the benchmark. The analytical report and the Stormwater Discharge Monitoring
Report (SOO) are attached.
ARM appreciates the opportunity to provide environmental services to Mann -Hummel. As required by the
stormwater permit, please sign the second and third pages of the attached SOO and then forward the
report to the NC DENR-Central Files at the Division of Energy, Mineral, and Land Resources at the
address shown on page 2 of the Stormwater Discharge Monitoring Report. Please call us at 704-369-
0621, if you have any questions.
Sincerely.
AR nvironmental Services, Inc.
rm McCorkle
Project Manager
cc: Central Files, DENR-Division of Energy, Mineral, and Land Resources
11164 DOWNS ROAD, PINEVILLE NC 28134 / f704) 369-0621 fax [phone] / www.armenv_com

Fable 1. Stormwater Sampling Results
Stormwater
Parameters
Units
OutfallI
Outfall2
Outfall3
Benchmark
Oil And Grease
mg/L
NA
ND
NA
30
PH
s.u.
NA
6.00-field
NA
Within 6,0-9.0
Total
Suspended
Solids
mgfL
NA
TS
NA
100
COD
mg/L
NA
190
NA
120
Total Rainfall
inches
NA
0.69
NA
-
Storm Duration
minutes
NA
240
NA
-
Total Flow
gallons/
minute
NA
1 0
NA
-
ND = Not Detected
mg/l = micrograms per litter (parts per million equivalent)
s.u.= standard pH units
NA = Not Analyzed

STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and land Resources General Permit No. NCG060000
Date submitted 3 .� f
CERTIFICATE OF COVI RAGE O. NCG 6Q 7 S
FACILITY NAME � %_ r -4- , iv�L
COUNTY DCt5 ,11'�
PERSON COLLTING SAMPLES
LABORATORY i t, , t_t Lj,S _ Lab Cert. f#
SAMPLE COLLECTION YEAR :- n 1 n
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec .--V--
or P_Nionthlys ` - month
DISCHARGING TO CLASS ❑ORW []HQW bTrout. ❑PNA
❑Zero -flout []Water Supply []SA
[Other
FACILITY ACTIVITIES INCLUDE (check all that apply):
use/process meats ❑ use animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE --)
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfail a or ❑ No discharge this period,;
Outfall No.
Date Sample
Collected, mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform,
Colonies per 100 ml
Enterococci,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 — 9.0
120
30
1000'
Soo,
Parameter Code
-
C0530
06400
00340
00S56
31616
61211
�j r,
I Only applies to facilities that use/process meats.
;The total precipitation must be recorded using data from -an on -site rain gauge.
'For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SMonthly sampling (instead of semi-annuai) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes ❑ no (if yes. complete Part 8)
Permit Date:11/1/2018-05/31/2021
SWU-249, Last Revised 11/5/2018
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Date Sample Collected
(mo/dd/yr j
24-hour rainfall amount,
Inchesx
New Motor Oil or
Hydraulic Oil Usage
Non -Polar O&G/Total
Petroleum Hydrocarbons
Total Sus Fended Solids
Benchmarks
-
-
-
15 mg/L
100 mg/L or 50 mg/O
Parameter Code
-
46529
NCOIL
00552
C0530
Footnotes from Part A also apply to Part B
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART It SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
* TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE QUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR, including all "No Discharge" reports within 30 days of receipt of the lab results (or of end of monitorinq period in the case
of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUSTSIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
N 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."
ure of Permittee
Date
Permit Date:11/1/2018-05/31/2021
SWU-249, Last Revised 11/5/2018
Page 2 of 2

ED
::.SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORTRECEIV
for North Carolina Division of Water Resource General Permit No. NCG060000
Date submitted ^3t/�^_
CERTIFICATE OF CO ERAGE N . NCG06p s r h
FACILITY NAME .
COUNTY
PERSON COLLECTING SAMPLES
LABORATORY - Lab Cert. #
Part A: Stormwater Benchmarks and, Monitoring Results
DEC 14 Zola
CENTRAL FILES
SAMPLE COLLECTION YEAR 2 1-- I S2 &_ � SECTio:, �
FACILITY ACTIVITIES INCLUDE (check alf that apply):
use/process meats .0 use animal fats/byproducts
DISCHARGING TO SALTWATERS?`YES [RIq'0
-PLEASE REMEMBER TO SIGN ON THE R Et;SE
-Total event roinfall2 or o discharge this period`
Outfall No.
Sample Collected,-
mo/dd/yr .--
TSS,
mg/L
pH,
Standard units
COI],
mg/L
oil and Grease,
--.mg/L
Fecal Collform ,_
Colonies.per-100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 - 9.0
120
30
1000
Sao
' Only applies to Facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
It See General Permlt text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
outtall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
30
100 or 50
6.0 - 9.0
-
Only applies to facilities that use/process meats.
The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
°See Genera) Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if Yes, complete Part €3)
SWU-249 I-wo Reviscd: Ociober Ih, 2012
Page I nl'2

Part B: Vehicle Maintenance Area Monitoring Results. only for facilities averaging s 55 gal of new motor oil/month.
Outfall No.
Date Sample Collected
(mo/dd/yr)
24hour rainfall amount,
Inches'
New Motor Oil or
Hydraulic Oil Usage
Non -Polar O&G/Total
Petroleum Hydrocarbons
Total Suspended Solids
Benchmarks
-
-
-
15 mg/L
100 mg/L of 50 mg/O
Parameter Code
-
46529
NCOIL
00552
C0530
Footnotes from Part A also.apply to Part B
*FOR PART A AND PART B MONITORING RESULTS:
A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 E:XCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD a OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL- OFFICE?- YES ❑ NO
REGIONAL OFFICE CONTACT NAME.
Mail an original topy_of this DMR, intludinrt a1I "IVo Discharge" reports, within 30 days of_reCeipt of the lab results for at end a�monitoring period in the case
of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations."
- ,
Signature of Permittee
Permit Date: 11/1/2018-05/31/2021
I'd1oho
Date
SWU-249, Last Revised 11/5/2018
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Resourc s General Permit No. NCG060000
Date submitted
CERTIFICATE OF CO ERAGE N . NCG060a< MPLE COLLECTION YEAR 2G! y
FACILITY NAME CL - `�Ulij-c- Ctw {GI.� FA. IUTY AC
TtV17lES INCLUDE (check all that apply):
COt1i1ITY' c--{�,.1 _ QU M use/process meats ❑ use animal fat /byproducts
PERSON COLLECTING SAMPLES _ ..�.., DISCHARGING TO SALTWATERS? OYES LO
LABORATORY Lab Cert. # niWR S C f4 1110
_....� . 5i=CTID�
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REV SE -)
Total event rainfall I or o discharge this periods
Outfal! No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
Con,
mg/L
Oil and Grease,
mg/L
Feral Caliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
Soo
Only applies to facilities that use/process meats_
'The total precipitation must be recorded using data from -an on -site rain gauge. — -- --
;For sampling periods with no discharge at any outfalls_.You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes 11 no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfali No.
Sample Collected,
mo/dd/yr
oil and Grease,
mg/L
TSS,
mg/L
PH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50
6.0 — 9.0
-
(if yes, complete Part B)
Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge-
3 For sampling periods with no discharge at &ny outfalls, you must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. -
SWU-249 Isasl Revised:Oclolx.-r IR, 2012
Pagc I of 2

y
'FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.. SEE PERMIT PART II SCCTION R.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY 6NE OUTFALL? YES.,j_j NO _1
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE?
REGIONAL OFFICE CONTACT NAME:
Mail an ariainal and one copy of this DMR, including all "No Discharge" reports, within 30 days o receipt a pf the lab results (or at end of
monitoring period in the case of "No Discharge" eports to.
a.
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."
rt-
(Signature of Permittee)
a ,l�
(Date)
Additional copies of this form may be downloaded at: http:[/portal.ncdenr.org/web/vr�[sLF/nl2dessw$$tab-4
SWU-2 t9
1_,0M RCV i.M:d: IN, 2012
1,:kgC21 of

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Re our es General Permit No. NCG060000
Date submitted
CERTIFICATE OF OVERAGE NO. NCG0GQ�� L
SAMPLE COLLECTION YEAR cal K
FACILITY NAME �VIC{,;:,_ 8y j_k Q(,o�e �w�­zt� Y-1 FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY j� �v C i r - s 1� use/process meats ❑ use animal fa/byproducts
PERSON COLLECTING SAMPLES 1 ECENDISCHARGING TO SALTWATERS? [-]YES O
LABORATORY Lab Cert. it DEC i 4 zQm
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILE&
Part A: Stormwater Benchmarks and Monitoring Results CWR SF( -TV)- Total event rainfall a or Cq<o discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococcl ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
500
Only applies to facilities that use/process meats.
zThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls..You must still submit this discharge monitoring report with a checkmark here. -
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? L] yes ❑ no (if yes, complete Part R)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 58
6.0 — 9.0
Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
S W U-2 9 Last Revised: Octal er 19, 2012
Pagc: I of 2

*FOR PART A AND PART S MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 1I SECTION B.
* TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an on final and one-EM of this DMR including all "No Dischar e" re arts within 30 da s ot receipt ot the lab results for at end o
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 of Permittee)
2)
(Date)
Additional copies of this form may be downloaded at: htt j2://portaLncdenr.orp/web/wet/ws/su/npAessw#ttab-4
S W U-249
Lasi Revised: October 18, 2012
Page; 2 42

I
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT RECEIVE
for North Carolina Division of Water Res ur es General Permit No. NCG060000 DEC 14
2018
Date submitted
CENTRAL FILES,
CERTIFICATE OF C VERAGE NO. NCG06 S l SAMPLE COLLECTION YEAR �A DWR SECTION
FACILITY NAME Mv" �'. t d C 0� �'J� U - FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY use/process meats use animal fats/byproducts
PERSON COLLEgING,SAMPLE %YM DISCHARGING TO SALTWATERS? AYES [TNO
LABORATORY j 1' e S,y% Lab Cert. # Lt O
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A:.Stormwater Benchmarks and Monitoring Results Total event rainfall 1 0.0 or Na discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr __
TSS,
mg/L
pH,
Standard units
COD,
mg/L
fail and Grease,
mg/L
Fecal Conform ,
Colonies per 10D ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 — 9.0
120
30
1000
QD
v tU I
Z,
1 _. _ _._--_-
Only applies to facilities that use/process meats.
zThe total precipitation must be recorded using data from an on -site rain gauge.
' For sampling periods with no discharge at a, ny outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
PH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 504
6.0 — 9.0
Only applies to facilities that use/process meats.
The total precipitation must be recorded using data from an on -site rain gauge.
A For sampling periods with no discharge at arry outfalls, you must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if yes, Complete Part B)
5WU-249 I_:Lst RCvis4LL 00ilhcr 19, 2012
Pagi, I ul" 2

i
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? 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 lob results for at end_o
monitoring p_ eriod 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 CERTIFlCAT101V 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)
/0-� Cl / 2)
(Date)
Additional copies of this form may be downloaded at: http: /portal.nedenr.org/web/wgLws/su4npdessw#tab-4
S W IJ-249
I_.ast Revised: October 18, 2012
Page 2 of 2

STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCGOISOR CEI VED
Date submitted �Wu LF
CERTIFICATE OF COVERAGE NO. NCG06(735SL
FACILITY �NAME1y�,.„ _k& l.,,,_ rlti%. V' 1+� C�W r �0J
COUNTY �q,4�,\
PERSON COLLKTING SAMPLES
LABORATOR , Lab Cert. #i
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 20 -
DEC 14 2018
CENTRAL FILES
DWR SECTION
SAMPLE PERIOD ❑ Jan -June 0 July -Dec
or ❑ Monthlys (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑5A
❑Other
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 2 or n No discharge this oeriod'
Outfall No.
Date Sample
Collected, mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Cotiform,
Colonies per 100 ml
Enterococci,
Colonies per 100 ml
Benchmork
-
100 or 504
Within 6.0 — 9.0
120
30
1000a
5001
Parameter Code
-
C0530
00400
00340
00556
31616
61211
C
1I w, t
+ �
C>
ty,
I. - r
Onty applies to facilities that use/process meats.
z The total precipitation must be recorded using data from an on -site rain gauge.
'For sampling periods with no discharge at any outfails. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
')Monthly sampling (instead of semi-annual) most begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes /no (if yes• complete Part B)
Permit Date: 11/1/2018-05/31/2021 SWU-249, Last Revised 11/5/2018
Page 1 of 2

'FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE'SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO a
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, includinq alI "No Discharge" reoorts within 30 days of receipt o the lab results or at end o
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 of Permittee)
r�
� bd/ a -
(Date)
Additionat copies of this form may be downloaded at: http://portal_ncdenr.org/web/wcglws/su/npdessw#tab-4
5 W U-2 i 9
I-ast Revised: Octohcr 19, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water QuafiGeneral Permit No. NCG060000
Date submitted
�
CERTIFICATE OF C VERAGE NO. NCGO U SAMPLE COLLECTION YEAR
FACILITY NAME — d�u�-e �'�J;�c�: FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY �,r�c �rr✓1 _ qrt \05t _ ' ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLL 1NG SAMPLES -:;LT,— 4,1 e'G`e!(Tplp ,VC TO SALTWATERS? OYES ONO
LABORATORY Lab Cert. # G/ i) Q L' i j
MAY 20fEASE REMEMBER TO SIGN ON THE REVERSE -�
Part A: Stormwater Benchmarks and Monitoring Results CENTRAL FILEAotal event rainfall 2 20 or ❑ No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
mg/L
CTMaind Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or S0
Within 6.0 — 9.0
120
30
1000
1 Soo
Only applies to facilities that use/process meats.
1 The total precipitation must be recorded using data from an on -site rain gauge.
For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes [:]no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > S5 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Olt and Grease,
mg/L
TSS,
mg/L
pH.
Standard units
New Motor Oil usage,
Annual average gal/rno
Benchmark
-
30
100 or 504
6.0 — 9.0
-
' Only applies to facilities that use/process meats.
IThe total precipitation must be recorded using data from an on -site rain gauge.
3 For.sampling periods with no discharge at ate( outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if Ves, complete Part B)
S W I)-249 Lasi Revised: Ocluber 18, 20 1. 2
Page I of 2

-*4.
"FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL. OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMncluding_al! "No Discharge" reports, within 30 days of receipt_of the lob results for at end o�
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permitteej
a1
(Date)
Additional copies of this form may be downloaded at: http:LLportal.ncdenr.org/webLwgLws(su/ripdessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Liality General Permit No. NCG060000
Date submitted l
CERTIFICATE OF
FACILITY NAME
COUNTY ldtS
PERSON COLLECTING SAMPLES
LABORATORY Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR Z a (R
FACILITY ACTIVITIES INCLUDE (check ail that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? []YES ❑NCr'
PLEASE REMEMBER TO SIGN ON THE REVERSE -1
Total event rainfall z or o discharge this period
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Collform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
Soo
' Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
`See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per months? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50
6.0 -- 9.0
-
y applies to facilities that use/process meats.
2 The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you muststill submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if yes complete Part B)
SWU-249 1_.ast Revised: October 18, 2012
Page 1 of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
2 EXCEEDANEES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO 1�
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? 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_re�sults (or at end of
monitoring period In the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUSTSIGN 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)
--.5WJ1&-
(Date)
Additional copies of this form may be downloaded at. http://portal.ncdenr.org/web/wtt/ws/su/npdessw#tab-4
S W U-249
Last Revised: Ooober 18, 2012
Pala: 2 of 2

CERTIFICATE OF CQVERAGE
FACILITY NAME La,,,
�-�
COUNTY �s._, S�,,L\
PERSON COLLERIN� SAMP
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Q ME
'y General Permit No. NCG060000
Date submitte y RECEIVED �� D
NCG 5
'" �`}`K l Diu SAMPLE COLLECTION YEARl) f�
7.0��
i .: - MAR 0 5 2018
e C� , 4f?C9 FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats E] use animal fiats/bypr6dUt AL, FILES
DISCHARGING TO SALTWATERS? ❑YES A� DWR SECTION
LABORATORYf Gh &b52 Ntc rt i Lab Cert. fi L G
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE -i
Total event roinfoll 2 or [] No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliformx,
Colonies per 100 ml
Enterococcii,
Colonies per 100 ml
Benchmark
-
100 or SW
Within 6.0 - 9.0
120
30
1000
S00
L19
2sz
1 Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or SO4
6.0-9.0
-
° Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 3, identifying the especially sensitive recelving water classifications where the more protective benchmark applies.
(if yes, complete Part e)
SWU-249 Last Revised: Oclober 18, 2012
Page I of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER I REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
* 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PANT II SECTION Py
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCFEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES [:] NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME -
Mail
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel property 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)
- -I13
(Date)
Additional copies of this form may be downloaded at: http./Zportal,nctienr.orp/web/vdq/ws su/ripdesswhtab-4
SIV U-2,19
Last Rcviscd: Octoher 18, 2012
Page 2 oi'2

JAN 19-2018SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
OWR SECTIDt g prth Carolina Division of Water ual,t General Permit No. NCG060000
1r�FoRF,�A�ol� PRoel=s 1� f
Date submitted d Zd
CERTIFICATE OF VERAGE NO. NCG06Qjfa � Ct:++L� :t�t�` rn' MPLE COLLECTION YEAR a
FACILITY NAME f A&#..+, - 4-6%&'V� NE t - (�� ►� CFACILITY ACTIVITIES INCLUDE (check all that apply):
COON Q use/process meats ❑ use animal f /byproducts
PERSON OLLE�TING SAMPLES ��KIQ DISCHARGING TO SALTWATERS? DYES " NO
LA130RATORY
Lab Cert. Ii 662-2--
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE -)
Total event rainfall'_ or ❑ No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Collform',
Colonies per 100 ml
Enterococcil,
Colonies per 100 mi
Benchmark
-
100 or SW
Within 6.0 — 9.0
120
30
1000
Soo
'b
1z
;-t- t
Z
z .,
15 0
v
C d
'3
t
r
%`
' Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
s For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ' "no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or SO4
6.0 — 9.0
-
' Only applies to facilities that use/process meats.
zThe total precipitation must be recorded using data from an on -site rain gauge.
' For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if yes complete Part B)
SWU-249 Last Revised: October 18, 2012
Page I of 2

,� -
*FOR PART A AND PART B MONITORING RESULTS:
a A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
+ 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTIO�N.�B%.
* TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES n NO L1
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail an original and one _copyof this DMR, including aU "No Discharge"_ r�orlts, within 30 days of receipt of the lab results !or at end of
monitoring period in the case o "No Discharge" re orts to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
U-6,Mz Jwj&",k-; 1-L -.1nl8
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.orp web/wq/ws/su/np_dessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000 RECEIV5D
Date submitted ? �-2,9 t/
CERTIFICATE OF COVERAGE NO. NCG06 rl '� SS i
FACILITY NAME 1,\') r k
COUNTY e- 4,­-
PERSON COLLECTING SAMPLES-/
iABORATORYO/` cam, ��� Fli-� Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
AUG 1 0 2015
SAMPLE COLLECTION YEAR
FACILITY ACTIVITIES INCLUDE (check all that apply): CENTRAL FILES
❑ use/process meats ❑ use animal fats/byprodCu) R SECTION
DISCHARGING TO SALTWATERS? []YES [3NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
J/
Total event rainfoll 2Gl/s or ❑ No discharge this period3
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform',
Colonies per 100 ml 1
Enterococci',
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 - 9.0
120
30
1000
Soo
A n r,/l -A/, Ct?Me,
/ , /
-`7 /
4,
i
Liie-
A[; r
rli� fl %n l r � ! -'
/2^7 on /J a4/F
z Only applies to facilities that use/process meats.
z The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or SW
6.0 - 9.0
-
(if yes, complete Part B)
' Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
'For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
"See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: Oclobcr 18, 2012

*FOR PART AA ANQ PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART If SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mail an original,and one copy of this DMR, including -all "No Discharge" reportswithin 30 days Qf receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. l am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
(SignatuW of Perm
1 2-0S
(date)
Additional copies of this form may be downloaded at: http //portal.ncdenr.orglweb/wq/ws/su/npdessw#tab-4
SWLJ-249 Last Revised: October 18. 2012
D-b- l „r I

�`��
MCDD ENR
Storinwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit tt /t ort;il.ncdenr.org/tivebl/ vct/ws/su/npdesswlftah-4
Permit No.: N/C/i! I /L/r)/'�f��/ or Certificate of Coverage No.: N/C/G/{7/ /�/, I 1 I
Facility Name: 1t}T /}`< <?c�l,r !��%s �, ,,lv. GA-4.:�
County: (__Ias ,-✓% _ Phone No."10LI --6 -
Inspector:
Date of Inspection: -1 / 1 c!
Time of Inspection: `r
,1
Total Event Precipitation (inches): <`) -
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
l Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
i signaturree, I certify this repoorr'ttiiis accurate and complete to the best of my knowledge: By th
e 0��)
(Sign
ature of Permittee or Designee) U
Page 1 of 2

1. Outfall Description:
Cutfall No. 07 1 Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the,i }n}dustrial acjjtivitiesl!that occur. within the outfall `drainage area: fh t'/kt !j,• 1cT_45.�'i G.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: U(' I,'C n
L)
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): f\ On O
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
k�D 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
(1) 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 ) 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
a. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes Co
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2

A` 1;mA
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: htt I)ortal.nrd n�arglweb/wq/wsf su/nl2dess�vH tab-4
Permit No.: N/UI/v/
Facility Name: 10, x
County: L,e-A
Inspector: rho
Date of Inspection: '7 1 t 4 l IN
Time of Inspection: 1-), 3':�3
or Certificate of Coverage No.: N
Phone No. ''7J-t- �4l c) —': `'l0 (C
Total Event Precipitation (inches):' /
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
1[]Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "rneasureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
.1 A P � /,,l
(Signature of Permittee or Designee)
Page 1 of 2

1. Outfall Description:
Outfall No. 7- Structure (pipe, ditch, etc.) 7 f
Receiving Stream:l,1�,'Y�,M,z,: -� r L, - ca - �a�r�.. !� t �•:,c(•S�a �r11i#��ic t�-+� rr`
Describe the industrial activities that occur within the �ofutfali drainage area: iii�, A �
Af fii' /_- (4, '10(C " 6L7_17.1' 1)t.'i i. %�Ji. 1�1: �[ ✓1 /t f {`
r I JV ✓
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Li l_l, i
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): k. c: ,-1 t;
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 s 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 (1 3 4 5
7. Is there any foam in the stormwater discharge? Yes 'No--1
8. Is there an oil sheen in the stormwater discharge? Yes CNo�
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2

NCDER
Storinwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: ht%//portal.ncdenr.oEgLvvaW vn ws su n dessw#tab-4
Permit N(
Facility N
County: C.
Inspector: sl i, ),
Date of Inspection: -71 1 4 11
Time of Inspection: l • S
c�
Total Event Precipitation (inches): r�
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
O'Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
t
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
..... ... ._. ...._............... .....................
By this slgnatuure,.I certify that this report is accurate and complete to the best of my knowledge: or�14K 1-,W,
(Signature of Permittee or Designee) 411
Pagel of 2

1. Outfall Description:
Outfall No. 0J i Structure (pipe, ditch, etc.)
1
Receiving Stream: U;\ Am-w- j 4r � ---.,
Describe the
//industrial /activities that occur within the outfall drainages area: I),A .�
/,, Iq-4 `17Z'[:f� /7; rtr� c'.� %lr�)— 5y �r� +Q.hGt/?t6C4pr'
a r v i
Tuft /L.i.ctit.{"
{4'
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _� /.�� '-f'ran✓�
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 S
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:
CD,-) 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes � o
8. Is there an oil sheen in the stormwater discharge? Yes No
4. Is there evidence of erosion or deposition at the outfall? Yes [Vo
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2

/PRIS
MI
I Ftitl-Sertiice Analyticai $
Environmental solutions
ARM Environmental - Charlotte
Tim McCorkle
11164 Downs Rd.
Pineville, NC 28134
NC Certification No.402
SC Certification No.99012 Case Narrative
NC Drinkinq Water Cert No. 37735
0712812015
VA Cettfcatiw No. 460211
DoD ELAP. L-A-B Accredited Certificate Na. L2307
ISonEC 17025: L-A-B Accredited Ceriirwate No. L2307
Project: Wix - Mt. Olive Church Rd. Stormweter
Lab Submittal Date: 07/1512015
Prism Work Order: 5070294
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 rase
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.
Rabbi A. Jones
President/Project Manager
Data Qualifiers Key Reference:
Reviewed 8y Robbi A. Janes
President/Project Manager
BRL Below Repotting 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, urithovt the written consent of Prism Laboratories, Inc.
A49 5pringbrock Road -P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]S Page 1 of 8

i Furl-3arviCe Ai-agv-:GU1 R
r
..PR Envrre�nA�t�n S:.rl S�Jwionx
Sample Receipt Summary
07/2812015
Prism Work Order: 5070294
Client Sample 1D Lab Sample ID Matrix Date Sampled Date Received
001 5070294-01 Water 07/14/15 07/15/15
002
5D70294-02 Water 07/14115 07115/15
003 5070294-03 Water 07114/15 07115/15
Samples were received in goad condition at 2.0 degrees C unless otherwise noted.
This report should not be reproduced, excopt in its entirety, without the written wn5ent of Prism Laboratories, Inc.
449 5pringbrook Road -P.O. Box 240543 - Charlotte, NC 28224.0543
Phone: [phone] - Toll Free Number. 1.800/529-6364 - Fax: [phone] Page 2 of 8

p R S M I Envm,'vlce r�nalyt,cnl 8
Env nnn monml Salution5
ARM Environmental - Charlotte
Attn: Tim McCorkle
11164 Downs Rd.
Pineville, NC 28134
Project: Wix - Mt. Olive Church Rd.
Stormwater
Laboratory Repot
Prism Work Order. 5070294
07t2a/2015
Field Data
Laboratory ID Client ID Field Parameter Result
5070294-01' 001
pH 6.5
5070294-02
5070294-03
002
003
PH
6.0
PH 6.5
This report should not tie faprodu"d, except In As entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.Q. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number. 1.8001529-6364 - Fax: [phone] Page 3 of B

n R I S ]� n I FullSarv,co nnalytrw! d
r � V' i Envirnn nsaicn! So�u[rona
Laboratory Report
07/2812015
ARM Environmental - Charlotte Project: Wix - Mt. Olive Church Rd, Client Sample ID: 001
Attn: Tim McCorkle Stormwater Prism Sample ID: 5070294-01
11164 Downs Rd. Prism Work Order: 5070294
Pineville, NC 28134 Sample Matrix: Water Time Collected: 07114115 12:45
Time Submitted: 07/15115 11:54
Parameter Result Units Report MOL Dilution Method Analysis Analyst Batch
Limit Factor Date/Time ID
General Chemistry Parameters
Chemical Oxygen Demand Ito mglL 50 5.3 1 'SM5220 D 7127115 14:30 COL P5GD490
Oil S Grease (HEM) BRL mg/L 5.0 0.48 1 '1664B 7127115 17:32 ARC P5G0504
Total Suspended Solids 12 mg/L 2.9 oleo 1 ISM 2540 O 7116115 15:25 EGC PSG0289
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 23224.0543
Phone: [phone] -Toll Free Number. 1400/529-6364 - Fax: [phone] Page 4 of 8

%� I Full-Sur,;ice Ar, r:ly Efcnl 3
1 [��irournoatnl Su'�tron6
.wpAh� W:t ut
ARM Environmental - Charlotte
Attn: Tim McCorlde
11164 Downs Rd.
Pineville, NC 28134
Project: Wix - Mt. Olive Church Rd
Stormwater
Sample Matrix: Water
Laboratory Repprt
07/2812015
Client Sample ID: 002
Prism Sample ID: 5070294-02
Prism Work Order: 5070294
Time Collected: 07/14115 12:30
Time Submitted: 07/15/15 11:54
Parameter
Result
unil9
Report
MDL
Dilution
Method
Analysis Analyst
Batch
Limit
Factor
Dateltme
ID
General Chemistry Parameters
ChomIcal Oxygen Demand
690
mg1L
50
5.3
1
'SM5220 D
7127115 14:30 CDL
P5G0490
0I1 & Grease jHEMI
BRL
mgk
5.0
0.48
1
'166413
7127115 17:32 ARC
PSGO504
Total Suspended Solids
71
mgfL
8.3
0.80
1
'SM 2540 D
7116115 15:25 EGc
P5G0289
This report should not be reproduced, except In its entirety, without the written consent of Prism Laboraforin, Inc.
448 Springbrook Road - P.O. Box 240543 - charlotte, NC 28224.0543 777
Phone: [phone] - Toll Free Number: 1.8001529-6364 - Fax: [phone] Page 5 of 8

/ P R I S M I Fu0-Snrv,cn Analy[iC11 8
[nvirgrlm n�fi��l So 4q mn5
Laboratory Repnrt
0712MOl5
ARM Environmental - Charlotte
Project: Wix - Mi. Olive Church Rd.
Client Sample ID: 003
Attn: Tim McCorkle
Stormwater
Prism Sample ID: 5070294-03
11164 Downs Rd.
Prism Worts Order: 5070294
Pineville, NC 28134
Sample Matrix: Water
Time Collected: 07/14115 12:55
Time Submitted: 07/15115 11:54
Parameter
Result Units
Report MDL
Dilution Method Analysis Analyst
Batch
Urnh
Factor DateMme
ID
General Chemistry Parameters
Chemical Oxygen Demand
04 mg1L
50 5.3
1 'SN5220 D 7127115 14:30 COL
P5G0490
Oil 8 Grease (HEM)
BRL mg1L
5.0 0.48
1 '16548 7127115 17:37 ARC
PSGO504
Total Suspended Solids
5.7 mgiL
2.5 0.80
1 ISM 2540 D 7116115 15:25 EGC
PSG0289
This report should not be reproduced, except in its entirety, without the writlen consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0S43
Phone: [phone] -Toll Free Number. 1-8001529-6364 - Fax; 7041525.0409 Page 6 of 8

�j P n r S M I full-$orylGu F•�nlyum n
//'//� 1i•'ll If 11 YY fl Envirun mnianl Snluunns
ARM Environmental - Charlotte Project: Wix - Mt. Olive Church Rd
Attn: Tim McCorkle Stormwater
111164 Downs Rd.
Pineville, NC 28134
General Chemistry Parameters - Quality Control
Level II QC Report
7128/15
Prism Work Order: 5070294
Time Submitted: 7115/2015 11:54:OOAM
Rep"ng Spike Source %REC RPD
Anslyte Result Limit Units Level Result %,REC Limits RPO Limit Notes
Batch P5G0289 - NO PREP
Blank (PSG0299-13LK1) Prepared & Anatyzed: 07/16/15
Total Suspended Solids BRL 5,0 mg1L
LCS (PSG0189-BS1) Prepared & Analyzed: 07/16/15
Total Suspended Solids v490 5.0 mg1L 477.0 ^ 103 90-110
Batch PSCO490 - NO PREP
Blank (PS00490-BLKt) Prepared & Analyzed: 07/27/15
Chemical Oxygen Demand BRL 50 mg1L
LCS (PSG0490-8S11 Prepared & Analyzed: 67127115
Chemical Oxygen Demand 514 50 mg1L 500.0 103 90-110
Matrix Spike (PSG0490•MS1) Source: 5070294-01 Prepared &Analyzed: 07127/15
Chemical Oxygen Demand 653 50 rng& 500.0 157 99 80-120
Matrix Spike Dup (PSG0490-MSD1) Source: $070294-01 Prepared & Analyzed: 07/27115
Chemical Oxygen Demand 646 50 mg/1- 500.0 157 95 80.120 1 20
Batch PSGO504 - NO PREP
Blank (P500504-ELK1) Prepared & Analyzed: OV27115
Oil & Grease (HEM) BRL 5.0 mglL
LCS (PSG0504-BS1) Prepared &Analyzed: 07/27/15
Oil & Grease (HEM) 33.5 5.0 mgA- 40.00 B4 76.114
This repert should not be reproduced, except In its entirety, without the written consent of Prism Laboratorlea, Inc.
449 Springbrook Road - P.O. Box 940543 - Charlotte, NG 29224.0543
Phone; 7041529-6364 - Toll Free Number. 1.8001520-6354 - Fax: 7041S25-0409 Page 7 D6 8

ENVIRONMENTAL
SERVICES, INC.
ASSESSMENT & REMEDIAL SERVICES DIVISION
January 21, 2015 118ce, V �
,
FEB �
Ms. Amanda Clemmer 2 2015
Wix Filtration Products Division C8N
Mastr 551eMount101ive ChurchrRoad DER TRA
Cr/O S
N
Gastonia, NC 28052
RE: Stormwater Sampling Results - North Carolina General Permit No. NCG060000
Certificate of Coverage Number NCG060351
Semi -Annual 2014 Sampling
Wix Master Distribution Center
1551 Mount Olive Church Road
ARM Project No. 12-4028-14
Dear Ms. Clemmer:
In accordance with the North Carolina Department of Environment, and Natural Resources (NC DENR)
stormwater discharge permit, ARM collected semi-annual stormwater samples at the referenced facility
on December 22, 2014.
The samples consisted of three Stormwater grab samples from the facility stormwater outfall locations,
and the sample were collected during the rain event in clean, pre -preserved, laboratory -prepared sample
bottles. The samples were then delivered to Prism Laboratories, Inc., which is a North Carolina -
accredited analytical laboratory. The samples were analyzed for oil and grease, total suspended solids
(TSS), and chemical oxygen demand (COD), per the permit requirements.
The attached Table 1 provides a summary of the analytical results (also attached), total flow, and total
rainfall. All parameters were below the permitted range benchmarks except for TSS in Outfall 2 with a
detection of 120 mg/L, and COD in Outfall 2 with a detection of 420 mg/L. The pH was performed in the
field upon sample collection; was within the recommended holding time of 15 minutes; and showed
results within the permitted range benchmark value of 6.0-9.0. The Stormwater Discharge Monitoring
Report (SDO), which also shows the analytical results for the outfalls is attached. During sample
collection, qualitative monitoring of certain parameters was performed and the Qualitative Monitoring
Report for each outfall is attached.
ARM appreciates the opportunity to provide environmental services to Wix Filtration. As required by the
stormwater permit, please sign the second page of the SDO and then forward the report to the NC
DENR-Central Files at the Division of Energy, Mineral, and Land Resources in the addressed envelope
provided. Please call us at 704-369-0621, if you have any questions.
Sincerely.
A nviron/mental Services, Inc.
im McCorkle
Project Manager
cc: Central Files, DENR-Division of Energy, Mineral, and Land Resources
11164 DOWNS ROAD, PINEVILLE, NC 28134 / [phone] fax [phone] / www.armenv.com

Table 1. Stormwater Sampling Results
Stormwater
Parameters
Units
Outfall1
Outfall2
Outfall3
Benchmark
Oil And Grease
mg/L
ND
11
ND
30
PH
s.u.
6.5-field
6.0-field
6.5-field
Within 6.0-9.0
Total
Suspended
Solids
mg/L
14
120
12
100
COD
mg/L
ND
420
55
120
Total Rainfall
inches
0.26
0.26
0.26
-
Storm Duration
minutes
480
480
480
-
Total Flow
gallons/
minute
8
2
0.5
-
ND = Not Detected
mg/L = micrograms per liter (parts per million equivalent)
s.u.= standard pH units

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG06Q, 3 _S rI SAMPLE COLLECTION YEAR
FACILITY NAME )G c q �a -Ft 0,, ,.'4R_ r - FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLE NG SAMPLE 6*, r/ DISCHARGING TO SALTWATERS? []YES CJivO
LABORATORY Lab Cert. IT CA d
PLEASE REMEMBER TO SIGN ON THE REVERSE
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall z p.26 /r or ❑ No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
'ASS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Cailform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 - 9.0
120
30
1000
Soo
2 2a z
D
lu
rr 4
6/
2
L
G`C
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit tent, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes [ io (if yes, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or SCr
6.0 — 9.0
-
Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012
AanP 1 .,r 7

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART It SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALLTRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART it SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 40R MORE BENCHMARK EXCEEDENCES FOR THE. SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including al! "No Discharge" reports —within 30 days of receipt the lab results or at end o�
monitoring period in the case of "No Discharge" reports to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the p9ajsi0ty of fines and imprisonment for knowing violations."
of Permittee)
I /3D/l -(5
(D te)
Additional copies of this form may be downloaded at: http!/Iportal.ncdenr.orp/web/wq/ws/su/npdessw#tab-4
SWU-249
Last Revised: October 18, 2012

ALIT;
NCDENR
Stormwater Discharge Qutfall (SDQ)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: htt�/Iportal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
Permit No.: N/C/Q/(�/g©/C„/Q or Certificate of Coverage No.:
Facility Dame: i bu Crv-e-�
County- ,, /l Phone No.
InSpector:r l cm IF" t o t �
Date of Inspection:
Time of Inspection: 15 57�
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By, is ignatury, I certify that this report is accurate and complete to the best of my knowledge:
ignature of Permittee or Designee)
Page 1 of 2

1
[
f'
- � � � .. �
1 �, ��

1. Outfall Description:
Outfall No. 406 1 S
Receiving Stream: J)AA4►r
Describe the industrial ictiv_il
,A,
2. Color. Describe the color of the Oischarge psing basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
..
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):- Dale-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
G) 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:
6) 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes DNo
8. is there an oil sheen in the stormwater discharge? Yes No
9. is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation,
Page 2 of 2

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit. http://portal.ncdenr.orglweb/wq/ws/su/nl2dessw#tab-4
Permit No.: N/C/t.
Facility Na e: UA
County:
Inspector: �M'
Date of Inspection:
Time of Inspection: /': 3Sr
or Certificate of Coverage No.:/J/
Total Event Precipitation (inches): b--26
ff-
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." Flowever,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
ignature of Permittee or Designee)
Page 1 of 2

� � Ir /�
1
.i� � _
c
' - 1 �
=) ..

1. Outfall Description:
Outfall Nc&�^
Receiving Stream.
(pipe, ditch, etc.)
Describe,the industr"a[ ctivities that occurVvithin the
/,u,(—4,je—eI-Irn ; /r,-- /2,..,6 �,e
2. Color: Describe the color of the discharge
(light, medium, dark) as descriptors: e
6`e— /-- ,
it drainage area:
j A U
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.): 4 G
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 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:
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 3 4 5
7. is there any foam in the stormwater discharge? lies No
B. Is there an oil sheen in the stormwater discharge? Yes ED
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note. Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2

.i • �•rrl � t! �.�•���'��a � 1 �lS •� •per: ��•:3_ a S.•Y��'i �;: i�.lr. 1
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ALF-�WA
VA 8'
NCDENR
Stormwater-Discharge, OutfalI (SDO)
Qualitative Monitoring Report
` Forguidance on filling out this form, please visit b-UlInorta�.ncdenr.org/web/wq/ws/su/npdessw#tab-4
Permit No.: N/C/�lQ� D/o
Facility Name: r e
County:
Inspector: r
Date of Inspection:
Time of Inspection: 4c.- 2-c
Total Event Precipitation (inches):
or Certificate of C6verage No.: N/C
Phone No.
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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
he local DWQ Regional Office. obtains approval from the --....... _.... _... ........................ ..... .._._._._........ _............. ...............
By this, g ture, I cejtify that this report is accurate and complete to the best of my knowledge:
re of Permittee or Designee)
Pagel of 2

,� ..
' ��
..w ... 1. � � � � - -. .. • r .. �. _ . .. � . .
.� mil•. }� a � __
� t
y
{ r' I
. r
,j.

1. Outfall Description:
Outfall No. M Structu
Receiving Stream:
Describe the i dustri 1 activities
2. Color: Describe the color of the di
(light, medium, dark) as descriptors:
ditch, e c.) --el
VitVin the o tfbd drainage area:
�o ✓ fiti /���
basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (Le., smells strongly of oil,
weak chlorine odor, etc.): AjQ A �e— _
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
``
�� 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:
2 3 4 5
7. Is there any foam in thestormwatersto�rmwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
9. is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2

4.
KPR1SM
Full -Service Analytical &
Environmental Solutions
ARM Environmental - Charlotte
Tim McCorkle
11164 Downs Rd.
Pineville, NC 28134
NCCediflcationNo. 402 Case Narrative
SC Certification No, 99012
INC Drinking Water Cart No. 37735
VA Certification No. 460211 01/09/201
DoD ELAP: L-A-B Accredited Certificate No. L2307
ISOlIEC 17025: L-A-a Accredited Certifcals No. L2307
Project: Wix - Mt. Olive Church Rd. Stormwater
Lab Submittal Date: 1212312014
Prism Work Order: 4120461
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.
) ��_ i� .
(d_pv-�
Robbi A. Jones
PresidentlProject Manager
Data Qualifiers Key Reference:
6L, ca­­,
Reviewed By Robbi A. Jones
President/Project Manager
DL Sample concentration too low for RPD evaluation.
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 entirely, villhout the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240W • Charlotte, NC 28224-0543
Phone: 7OWS29-6384 -Toll Free Number: 14MIS29.6364 - Fax: [phone] Page 1 Of 8

Sample Receipt Summary
APR 18 M
fulbS rlinen-iGo at Sol do a
Envlronmentat Solutlona
01109/2015
uuon.taua wc.
Prism Work Order: 4120461
Client Sample ID
Lab Sample ID
Matrix
Data Sampled Date Received
001
4120461-01
Water
12/22/14 12/23/14
002
4120461-02
Water
12122/14 12/23/14
003
4120461-03
Water
12/22/14 12/23/14
Samples were received in good condition at 4.4 degrees C unless otherwise noted.
This report should not be reproduced, except In Its entirely, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road • P.Q. Box 240543 • Charlotte, NC 28224-0543
Phone: TW529414W -Toll Free Number: 1-800152943N -Fax: [phone] Page 2 of 8

fj •
PP.
IS M IFull-S*Mco Analytical 8
EnWronmental Solutions
=i1a
ARM Environmental - Charlotte
Attn: Tim McCorkfe
11164 Downs Rd.
Pineville, NC 28134
Project: Wix - Mt. Olive Church Rd.
Stormwater
Laboratory Report
01/09/2015
Prism Work Order. 4120461
Field Data
Laboratory ID Client ID Field Parameter Result
4120461-01 001
pH 6.5
4120461-02 002
pH 6.0
4120461-03 003
pH 6.5
This report should not be reproduced, except In its entirety, without the written consent of Prism Laboratorles, Inc.
449 $pringbrook Road • P.O. Box 240543 -Charlotte, NC 20224-0543
Phone: 704l529-6364 - Toll Free Number: 141=529-0364 - Fax: 704r525-0409 Page 3 of 8

Ln'© I S^ A I Fuulronmoe al Sol lio a
k ' V � �nvirbnmontal Solutions
w�ia M ire
Laboratory Report
01/09/2015
ARM Environmental - Charlotte
Project: Wix - Mt. Olive Church Rd.
Client Sample ID: 001
Attn: Tim McCorkle
Stormwater
Prism Sample ID: 4120461-01
11164 Downs Rd.
Prism Work Order: 4120461
Pineville, NC 28134
Sample Matrix: Water
Time Collected: 12/22/14 15:50
Time Submitted: 12/23/14 17:25
Parameter
Result Units
Report MDL
EQUI)n Method Analysis Analyst
Butch
Limit
Factor DaleMme
ID
General Chemistry Parameters
Chemical Oxygen Demand
BRL mg1L
50 5.3
1 'SM5220 D 12/30/14 12:50 CDE
P4L0469
Oil & Grease (HEM)
BRL mWL
&0 0.37
1 '1664B 117115 12:00 JAB
P5A0066
Total Suspended Solids
14 mgA.
3A 1.0
1 'SM 2540 0 12129I14 15:00 COO
P41-0456
This report should not be reproduced, except In Its entirety, without the written consent of Prism Laboratories, Inc.
440 Springbrook Road • P.O. Box 240543 • Charlotte, NC 20224-0543
Phons: 7041529-6364 - Toll Free Number: 1-000I329.6364 - Fax: [phone] Page 4 of 8

r
1, q
:..,FF? R I S M I e"ViroFull-SMmM. Ansolutiot Jw
1 Emirorrmantel Sarunpnp
Laboratory Report
0110912015
ARM Environmental - Charlotte
Attn: Tim McCorkle
11164 Downs Rd.
Pineville, NC 28134
Project: Wix - Mt. Olive Church Rd.
Stormwater
Sample Matrix: Water
Client Sample ID: 002
Prism Sample ID: 4120461-02
Prism Work Order: 4120461
Time Collected: 12/22/14 15:35
Time Submitted: 12123114 17:25
Parameter
Result
Units
Report
MOIL
Dilution
Method
Analysis Analyst
Batch
Llmlt
Factor
DafeMme
ID
General Chemistry Parameters
Chemical Oxygen Demand
420
mg1L
50
5.3
1
`SM5220 D
12130114 12:50 CDE
P4L0469
Oil a Grease (HEM)
11
mg1L
5.0
0.37
1
•16640
117115 12:45 JAB
PSA0066
Total Suspended Solids
120
mg1L
25
1.0
1
'SM 2540 D
12129/14 15:00 CDE
P41_0456
This report should not be reproduced, except In Its entirety, wllhaut the written consent of Prism Laboratories, inc.
449 Spr ngbroek Road - P.O. Box 240543 - Charlotte, NC 28224.0543
Phone: [phone] -Toll Free Number: 14001529-6364 - Fax: 704152"4o9 Page 5 0f 8

.JII--JR ISM I Full-garvien al Solution s
Environmental Solutions
'DS.�aav,mwca iwc
ARM Environmental - Charlotte
Attn: Tim McCorkle
11164 Downs Rd.
Pineville, NG 28134
Project: Wix - Mt. Olive Church Rd.
Stormwater
Sample Matrix: Water
Laboratory Report
01/09/2015
Client Sample ID: 003
Prism Sample ID: 4120461-03
Prism Work Order: 4120461
Time Collected: 12122/14 15:25
Time Submitted: 12/23/14 17:25
Parameter Result UNIS Report MDL Dilution Method Analysts Anetysl Batch
Limit Factor Datemme ID
General Cherittstry Parameters
Chemkal Oxygen Demand 55 mglL 50 5.3 1 'SM5220 D 12/30114 12:5D COE P41-0469
OII & Grease (HEM) BRL MOIL 5.0 0.37 1 '1664B 1/7115 1315 JAB P5A0066
Total Suspended Sands 12 mg1L 2.8 1.0 1 '5M 2540 0 12J29114 15:00 COE PAL0456
This report should not he reproduced, except In its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 282244543
Phona: 7041529.6364 -Toll Free Number: 1.8001529-63U - Fax: [phone] Page 6 of 8

Level II QC Report
Full-• �P R I S M I lanvir Omeneroice al Solutions
s 1 11
1 ERVIrOrlmanta! aol�ellana
�t�ueon�ronrs iwc
ARM Environmental - Charlotte Project. Wix - Mt. Olive Church Rd. Prism Work Order: 4120461
Attn: Tim McCorkle Stormwater Time Submitted: 12/23/2014 5:25:00PM
11164 Downs Rd.
Pineville, NC 28134
General Chemistry Parameter - Quailty Control
Reporting Spike Source %REG RPD
Anelyte Result Limit Units Level Result %REC Limits RP0 Limit Notes
Batch P41-0456 - NO PREP
Blank (1241-0456-BLK1) Prepared &Analyzed: 12/29/14
Total Suspended Solids BRL 5.0 m91L
LCS (P4L04W-BS1) Prepared & Analyzed: 12/29/14
Total Suspended Solids 440 5.0 mglL 468.0 94 90-110
Duplicate (124L0456-DUP1) Source: 4120461-02 Prepared &Analyzed: 12129/14
Total Suspended Solids 120 5.0 mg1L 120 0 20
11241-0469 - NO PREP
Blank (11240469-BLKI) Prepared & Analyzed: 12/30114
Chemical Oxygen Demand 13111- so mglL
LCS (P4L0469-BS7) Prepared &Analyzed: 12/30114
Chemical Oxygen Demand 505 50 mg/L 500.0 101 90-110
Batch P5A0066 - NO PREP
Blank (P5A0066-SLK1) Prepared & Analyzed: 01107/15
Oil & Grease (HEM) SRL 5.0 m01L
LCS (P5A0066-BS1) Prepared & Analyzed: 01/07115
Oil & Grease f HEM) 32.0 5.0 mg1L 40,00 80 78-114
Duplicate (P5A00664)UP1) Source: 4120461.01 Prepared & Analyzed: 01107/15
Oil & Grease (HEM) 1.11 5.0 mg1L 1 Al 24 18 DL
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240U3 - ChartetW NC 28224,0543
Phone: [phone] -Toll Free Number: 14001529�6364 -Fax: 704152"409 Page 7 of 8

�:!v.__-i/:.. ?:h:S.JO: ;' ..:':5•:'�:�'?{.j;l.}!tr.;.:. y_.;!� .y.:__•'ASS-._14'L J.Cu Y6Y•'t� r,�n -.�n.C-�vs��................ .. axxvl_J.,.v__w_. _r- u� 1 w. s •.J
_.Ill.__ _1.4v.•Jlwu.v .. .. __ .. .._____ _. _ ��._ �vaa�y,�-yx ��. �.�
CHA11� OF CUSTODY RECORD
F Iy M
IEnvService Analytical 8 Environmental Solutions ppOOF — plfpTp f!*p 04611RL PROPER BILLili82
r.wa/.,rTnRd:C INC } '` �` ,�Lr ry I 1
449 Springbrook Road • Charlotte, NC 28217 Project Name: ! A)L Jc ^ rr yl.. r C 1! �i �+1A .,
Phone [phone]- e4 Fax! 704ISM-0409 I Short Hold Analysis: (Yes) (No) UST Project: (Yes) (NO)
Client Company Name: . , "Please ATTACH any project Specific reporting (QC LEVEL 1 11 111 IV)
provisions anotpr QC Requirements
Report To/Contact Name: invoice To:
42
Reportin Address: T
Address:
s 'S fi Z5
Phone: -2rIN s (No): Purchase Order NoAIII Ing Reference TO BE FILLED IN BY CLIENTISAMPLING PERSONNEL
Emal! Addresst.^ r t` Ll3�� _ • z Requested Due Date ❑ 1 Day ❑ 2 Days ❑ 3 Days ❑ 4 Days ❑ 5 Days Certification: NELAC DOD FL NC L
EDD Type: PDF Excel hex '•Working Days" El S-9 Days ❑ Standard 10 days ❑ Ruses must Be SIC OTHER NIA
Site Location Name: /1 Samples received after 1CD0 will be processed next business day.
Site Location Physical Address. Turnaround time Is based an business days, excluding weekends and holldeys. Water Chlorinated: YES_ NCI
{SEE REVERSE FOR TERMS S. CONDITIONS REGARDING SERVICES
/1r RENDERED BY PRISMLABORATOA9a3, INC. TO CUENT) Sample Iced Upon Collection; YE L NO_
TIME
MAT=
SAMPLE CONTAINER
ANALYSIS
CLIENT
SAMPLE DESCRIPTION
DATE
COLLECTED
COLLECTED
IML A-9Y
(SOIL
WATER OR
PRESERVA•
71VESAkc
- Je
'TYPE
HOURS
SLUDGE)
SEE BELOW
NO.
SIZE
1D t
C�
zsa�r
/. ve
f
I
i
l
X
y—
k
I
Sampler's Signs Sampled By (Print Name) L= Affillation
Upon rollnquls this Chain of Custody Is your authorbmticn For Prism to proceed with the analyses as requested above. Any changes must be
subwtittsd In wrtting to the Prism Project Manager. There will be charges for any changes alter analyses have been InRialtaad.
3ANPLES ARE NOT ACCEPTED AND VERIFIED AGAINST COO UNTIL RECEIVED AT THE LABORATORY. ry1
❑ Fed Ex D UPS Hind-delnrerad ❑ PrisM Field SerHae U Other
DRINKLINGW
❑ NC D SCI ❑ NCU Rol D SC 1 0 NC D TER. I 0 NC El SCATER. I O❑ NC 0 SC SOLD WASTE. U NBC O SC I Q NC U SC I Q NC F❑ SC 0 NC ❑ SC
a ❑
"CONTAINER TYPE CODES: A = Amber C = Clear G= Glass P = Plastic; TL = Teflon4_Iried Cep VOA = Volatile Organics Analysis (Zero Head Space)
/PRISM
REMARKS
LAB
ID NO.
Jf
�`1Lr 1
O
r�
Comments:
OR GINAL.

A4
�a
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section DIVIfiU,N OF LAND RESOURCES
Tracy E. Davis, PE, CPM I AND P,atlMcCrory;cGbVernor
Director John E"Skvarla', III;'Secretary
November 27, 2013 DEC 4 2013
DEPAH I With I Ur -
Mr. Karl Westrick, Facilities Manager AND NATURAL RESOURCES
Wix Filtration
P.O. Box 1901
Gastonia, North Carolina 28052
Subject: General Permit No. NCG060000
Wix Master Distribution Center
COC No. NCG060351-
Gaston County
Dear Mr. Westrick:
In accordance with your application for a discharge permit received on November 6, 2013,
we are forwarding herewith the subject certificate of coverage (COC) to discharge under the subject
state - NPDES general permit. This permit is issued pursuant to the requirements of North Carolina
General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
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 Energy, Mineral and Land Resources (Division). The Division 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 or
permits required by the Division of Water Resources, Coastal Area Management Act or any other
federal, state or local governmental permit that may be required.
If you have any questions concerning this permit, please contact Bill Diuguid, Stormwater
Program Planner at telephone number [phone].
Sincerely,
ORIGINAL. SIGNED 8)
KEN PICKLE
for Tracy E. Davis
cc: Mooresville Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 • Telephone [phone] FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:llportal.ncdenr.org/web/lrlland-quality
An Equal Opportunity 1 Affirmative Action Employer -- 50% Recycled 110% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES "ISlQN OF ,
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060351 pw�+rrf DEC ��d13
STORMWATER DISCHARGES AND �rUAQ(E$�l�Ul._tflfi
Ultf;r�,
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 Environmcmtal Management Commission, and the
Federal Water Pollution Control Act, as amended,
Wix Filtration
is hereby authorized 10 discharge stormwater from a facility located at
Wix Master Distribution Center
1551 Mount Olive Church Road
Gastonia
Gaston County
to receiving waters designated as an unnamed tributary to Long Creek, a Class WS-I1; HQW waterbody to Catawba
River South Fork, Catawba River Basin; in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, 11, 111, IV, V and V1 ol'General Permit No. NCG060000, as attached,
This Certificate of Coverage shall become effective November 27, 2013,
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day November 27, 2013.
ORIGINAL SIGNED 6�
KEN PICKt
for Tracy E. Davis, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission

Map Name: GASTONIA NORTH Scale: 1 inch = 2,000 ft.
Print Date: 10/25/13 Map Center: 0350 16'58.44" N 081" 13'38.47" VV
Z:
y�a��`.rti -
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CD
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CD
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z
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7
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9 wvv.
Declination
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GN OL13: W001, w 081' 14'00.00" W 081- 13',30.00"
MN 7 26 W11
0 0
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W 081 - 13'00.
00" W 081' 12'301
1
Y-T
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SCALE 1:24000 SITE LOCATION MAP
1000 2000 3000 4000 5000 6000 WIX - MASTER DISTRIBUTION
CENTER
FEET GASTONIA, NORTH CAROLINA
FIGURE 1 JOB NO. 1151-001

_rjAbout
Features
Selected: ck r
1 � _
AKPAR: 215287
NBHD Info. GA033
INDUSTRIAL PIKE
PropertyAddress.
1551 NIT OLIVE
CHURCH RO
Dist Town 180'. e t :> �. •t. �tl
GASTONIA CITY
Current Owner 1 s -
GROWN �•c.' rig :5 yy";;� •�$ trx�t, r
GASTONIAASSOC "` ' . ' 1- _ •"ate - / C7
LLC
Current Owner 2 ~ ` " T
Owner 10: �• � •
1521519
9151559-
SalesAmount
14250000
Sales Date:
1212112007
Deed Type SWD
Deed Book 4375'
Deed Page 0386
Structure Type
WAREHOUSE 1 i'rs�t
Year BUILT. 1974 � � �i `, � • -
SQ Feet 539988
EXEMPT CODE:
LAND TYPF AC
LAND CODE:18 � ����� �•
Present use k
Value N
Calculated Acres ;, - 1•
3632 a
Flood Ares a. J „ • '
' r -
�{ X
1.00
or
tr ,, Y1�