NCG080716_MONITORING INFO_20190118

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV % D
DOC TYPE
❑HISTORICAL FILE
L� MONITORING REPORTS
DOC DATE
❑ ��%) % � � � Y
YYYYMMDD

January 8, 2019
Division of Water Quality
Attention: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Discharge Monitoring Report —July - December 2018
Pilot 46978
801 NC Hwy 211 E
Candor, North Carolina
Permit NCGO80716
Dear Sir/Madam:
RECEIVED
JAB! 18 2019
r,ENTRI AL FILES
UVIR SC-C 1'ION
Attached is the July - December 2018 Discharge Monitoring Report (DMR) prepared for the
above referenced site. The laboratory analytical data for this round of sampling is also attached. if
You have any questions. please feel free to contact me at [phone].
Sincerely,
Robert S. Wagner
Program Manager
Attachments
cc: Melody Mayville, Pilot Flying.l
Apex Companies, LLC - 7724 Garland Circle • Roanoke, VA 24019
T 540.563.4920 • F 540.563.4921 - apexcos.com

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 01/0/19
CERTIFICATE OF COVERAGE NO. NCGO80716
FACILITY NAME _Pilot 6978
COUNTY _ Montgomery
PERSON COLLECTING SAMPLES HC
LABORATORY SGS Lab Cert..# 346
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2018
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' (monthl
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
❑Zero -flaw ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE -i
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _x_no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
001
11/24/18
92.2
39.0
8.00
t For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11, 2013
PROP 1 M-)

STORM EVENT CHARACTERISTICS:
Date _11/24/18 (first event sampled)
Total Event Precipitation (inches): _>0.1
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
+ 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES NO
IF YES, HAVE YOU CONTACTED THE 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 results (or at end of monitoring period in
the case of "No Discharge" reportsl to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
/-10-If
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/weblwq/ws/su/npdessw#tab-4
SWU-250 last revised. April 11, 2013
Page 2 of 2

ATTACHMENT 11
Laboratory Certificates of Analysis
and Chain -of -Custody Documentation

04.
k
Dayton, y 12/05118 '
The results set Forth herein are provided by SGS North America hic. e-Hardcopy 2.0
Artloinaled Report
Technical Report for
Pilot Travel Centers LLC
ACVAR: #6978, 801 North Carolina Highway 211, East Candor, NC
SGS Job Number: JC78580
Sampling Date: 11/24/18
Report to:
Apex Companies, LLC
7724 Garland Circle
Roanoke, VA 24019
[e-mail]; and rew.street @apexcos.
ATTN: Robert Wagner
Total number of pages in report: 14
Test results contained within this data package meet the requirements
of the National Environmental Laboratory Accredilation Program
and/or stale specific certification programs as applicable.
B n McGuire
General Manager
Client Service contact: Tammy McCloskey 732-329-0200
Certifications: NJ(12129), NY(10983), CA, CT, FL, IL, IN, KS, KY, LA, MA, MD, ME, MN, NC,
011 VAP (CL0056), AK (UST-103). AZ (AZ0786), PA, RI, SC, TX, UT, VA, WV, DoD IiLAP (ANAB L2248)
This report shall not be reproduced, except in its entirely, without the written approval of SGS.
'lest results relate only to samples analyzed.
SGS North America Inc. • 2235 Route 130 • Dayton, NJ 08810 • I& 732.329-0200 • fax: [phone]
S6S is the .ohs authority for riud-imizine edits of ntodifivmiont to this document. I'lease share your ideas about ��(��
t.inamhnriieit im6 icatirnl 3)f This rol7fnl is stfic€ly M-ohibited. how we c,ut crvc you helicr al'.
Iteviom standard terms at; hitp:iAN%NNvs5,.c.aitti-cnry�nrm:-a€tid-conditions I:lis.I S.Custru,' nci(.aicr,sf s.eourn '
1 of 14
JC785a0

Sections:
Table of Contents
-I-
Section1: Sample Summary...................................................................................................
3
Section 2: Case Narrative/Conformance Summary..............................................................
4
Section3: Summary of Hits....................................................................................................
5
Section4: Sample Results........................................................................................................
6
4.1: JC78580-1: OWS-1......................................................................................................
7
Section5: Misc. Forms............................................................................................................
8
5.1: Chain of Custody...........................................................................................................
9
Section 6: C:encral Chemistry- - QC Data Summaries..........................................................
11
.................................
6.1: Method Blank and Spike Results Summary ......................... ........
12
6.2: Duplicate Results Summary ..........................................................................................
13
6.3: Matrix Spike Results Summary ......................................................... ............................
14
_SGSI_

SGS North America Inc.
Sample Summary
Pilot Travel Centers LLC
Job No: JC78580
ACVAR: 46978, 801 North Carolina Highway 211, East Candor, NC
Sample Collected Matrix Client
Number Date Time By Received Code Type Sample ID
JC78580-1 11/24/18 09:30 FIC 11/27/18 AQ Watcr OWS-1
3of14
_..VG -
JC78580

CASE NARRATIVE / CONFORMANCE SUMMARY is
Client: Pilot Travel Centers LLC Job No JC78580
Site: ACVAR: #6978, 801 North Carolina Highway 211, East Candor, N Report Date 12/5/2018 9:06:33 AM
On 11/27/2019, 1 Sample(s), O'rrip Blank(s) and 0 Field Blank(s) were received at SGS North America Inc, a1 a maximum
corrected temperature of 1.4 C. Samples were intact and chemically preserved, unless noted below. A SGS North America Inc. Job
Number ofJC78580 was assigned to the project. Laboratory sample ID, client sample ID and dates of sample collection are
detailed in the report's Results Summary Section.
Specified quality control criteria were achieved for this job except as noted below. For more information, please refer to the
analytical results and QC summary pages.
Compounds qualified as out of range in the continuing calibration summary report are acceptable as per method requirements when
there is a high bias but the sample result is non -detect.
General Chemistry By Method EPA 1664A
I Matrix: AQ Batch ID: GP17755
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC78460-1DUP, JC78460-1MS were used as the QC samples for HEM Oil and Grease.
Matrix: AQ Batch ID. GP17764
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this hatch meet method specific criteria.
■ Sample(s) JC78460-IDUP, JC78460-1MS were used as the QC samples for HEM Petroleum Hydrocarbons.
General Chemistry By Method SM2540 D-11
Matrix: AQ Batch ID: GN88846
■ All samples were analyzed within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC78591-2DUP were used as the QC samples for Solids, Total Suspended.
Field Data By Method SM4500Hf B-11
Matrix: AQ Batch ID: R174763
■ The data for SM45001.1+ B-1 l meets quality control requirements.
SGS North America Inc. certifies that data reported for samples received, listed on the associated custody chain or analytical task
order, were produced to specifications meeting the Quality System precision, accuracy and completeness objectives except as noted.
Estimated non-standard method measurement uncertainty data is available on request, based on quality control bias and implicit for
standard methods. Acceptable uncertainty requires tested parameter quality control data to meet method criteria.
SGS North America Inc. is not responsible for data quality assumptions if partial reports are used and recommends that this report
be used in its entirety. Data release is authorized by SGS North America Inc indicated via signature on the report cover
Wednesday, December 05, 2018 Page l of I
4of14
__IOU -
_
JUMBO

Summary of Hits
Job Number: JC78590
Account: Pilot Travel Centers LLC
Project: ACVAR: 46978, 801 North Carolina Highway 211, Fast Candor, NC
Collected: 1 i /24/ 18
Page 1 of 1
Lab Sample ID Client Sample ID Result/
Analyte Qua[ RL MDL Units Method
JC78580-1 OWS-1
HEW Oil and Grease 241 5.0 mg/l
HEM Petroleum Hydrocarbons 92.2 5.0 mg/1
Solids, Total Suspended 39.0 4.0 mg/l
pl-1 (Field) 8 su
EPA 1664A
EPA 1664A
SM2540 D- 11
SM45001-1+ B-11
5of14
-SGS_
JC78580

SGS
Dayton,
Sample Results
Report of Analysis
Section 4
r� i
'
_SG6of14
S;_
JC78580

SGS North America Inc.
Report of Analysis
Client Sample ID: OWS-1
Lab Sample 1D: JC78580-1 Date Sampled: 11/24/18
Matrix: AQ - Water Date Received: 11/27/18
Percent Solids: n/a
Project: ACVAR: 46978, 801 North Carolina Highway 211, East Candor, NC
General Chemistry
Analyte Result
HEM Oil and Grease 241
11EM Petroleum Hydrocarbons 92.2
Solids, Total Suspended 39.0
Field Parameters
pl-I (Field)
RL = Reporting Limit
8
Page IofI
RL Units DF Analyzed By Method
5.0 mg/l 1 12/04/18 16:00 'rM EPA 1664A
5.0 mg/l 1 12/04/18 16:30 'I'm EPA 1664A
4.0 mg/l 1 1 1/28/18 09:50 RC SM2540 D-1 I
su 1 11/24/18 09:30 SUB SM450011+ E3-1I
7of14
a-u� —a-us"-
Jc7a5aa

Dayton
Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
Section 5
A
-SGS8of14
T- JC78580

CHAIN OF CUSTODY PAGE OF
t
TEL. [phone]DO FAX 732-329,3499
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.1C78580: Chain of Custody
Page 1 of 2
9of14
JC78580

SGS Sample Receipt Summary
Job Number: JC78560 Client: APEX COMPANIES, LLC
Date 1 Time Received: 1 V2712018 3:00:00 PM Delivery Method:
Cooler Temps (Raw Measured) °C: Cooler 1: (1,7);
Cooler Temps (Corrected) °C: Cooler 1: (1.4);
Cooler Security Y
1. Custody Seals Present: M
or N
❑
Y or N
3. COC Present: ❑
2. Custody Seals Intact: v7
❑
4. Smpl Datesrrime OK ❑
Cooler Temperature
1. Temp criteria achieved:
Y or
11;;�
N
❑
2. Cooler temp verification:
IR Gun
3. Cooler media:
Ice (Bag)
4, No. Coolers:
1
Quality Control Preservation
1. Trip Blank present I cooler:
Y
©
or N
WJ
HIA
❑
2. Trip Blank listed on COG:
❑
F
❑
3. Samples preserved property:
R
❑
4. VOCs headspace free:
❑
Project: ACVAR: #6978, 801 NORTH CAROLINA HIGHW
Airbill # s:
Sample Integrity - Documentation
1. Sample labels present on bottles:
Y
or, N
❑
2. Contain arlabeling complete:
❑
3. Sample container label 1 COG agree:]
❑
Sampie Integrity - Condition
1. Sample recvd within HT:
Y
W
or N
❑
2. All containers accounted for,
W
0
3. Condition of sample:
Intact
Sample Integrity - Instructions
1. Analysis requested is clear:
Y
WJ
or N NIA
❑
2. Battles received for unspecified tests
❑
R
3. Sufficient volume recvd for analysis:
R
❑
4. Compositing instructions clear:
❑
❑
5. Filtering instructions clear:
❑
❑ WJ
Test Strip Lot #s: pH 1-12: 216017 pH 12+: 208717 Other: (Specify)
Rev, Date 12P117
JC78580: Chain of Custody
Page 2 of 2
C71
_SGS'
10 of 14
JC78580

SG9'
Dayton,
General Chemistry
QC Data Summaries
Includes the following where applicable:
• Method Blank and Blank Spike Summaries
• Duplicate Summaries
• Matrix Spike Summaries
Section 6
A�
��+++! 11 of 14
_.�7.1a7.._
JC78580

D
METHOD BLANK AND SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC78580
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: 06978, 801 North Carolina Highway 211, East Candor, NC
MS Spike BSP BSP QC
Analyte Batch ID RL Result Units Amount Result BRecov Limits
HEM Oil and Grease GP17755/GN89112 5.0 0.0
HEM Petroleum Hydrocarbons GP17764/GN89114 5.0 0.0
Solids, Total Suspended GN88846 4.0 •0.0
Associated Samples:
Batch GN88846: JC78580-1
Batch GPI1755: JC78580-1
Batch GPI7764: JC78580-1
(•) Outside of QC limits
Page 1
mg/1 40.05 35.1 87.6 78-114R
mg/1 20.01 15.8 79.0 64-132%
Mg/1
1 12 of 14
_S.GS�
JC78580

DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
r Login Number: JC78580
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: 06978, B01 North Carolina Highway 211, East Candor, NC
QC Original DU N
Analyte Batch ID Sample Units Result Result RPD Limits
HEM Gil and Grease
GP17755/GN89112 JC78460-1 mg/1 0.0 0.0 0.0 0-188
HEM Petroleum Hydrocarbons
GP17764/CN89114 JC78460-1 mg/l 0.0 0.0 0.0 0-34%
Solids, Total Suspended
GN86846 JC78591-2 mg/l 11.5 11.1 3.5 0-17%
Associated Samples:
Batch GN68846: JC78580-1
Batch GP17755: JC78580-1
Batch GP17764: JC78580-1
(') outside of QC limits
Page 1
SG C
c' 13ofi4
' Jc7aano

MATRIX SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
F Login Number: JC18580
Account: PILOTSS - Pilot Travel Centers LLC
" Project: ACVAR: #6978, 801 North Carolina Highway 211, East Candor, NC
QC Original Spike MS QC
Analyte Batch I6 Sample Units Result Amount Result &Rec Limits
HEM Oil and Grease GP17155/GN89112 JC70460-1 mg/l 0.0 40.05 35.4 88.4 78-114%
HEM Petroleum Hydrocarbons GP17764/GN89114 JC78460-1 mg/1 0.0 20.01 16.4 82.0 64-132%
Associated Sampies:
Batch GP17755: JC76580-1
Batch GP17764: JC76580-1
W
(`) Outside of QC limits
(N) Matrix Spike Rec, outside of QC limits
Page 1
Scc'
—.�Lir.
14of14
JC78580