NCG210028_MONITORING INFO_20190523

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
L) bd
DOCTYpE
❑HISTORICAL FILE
C`3-1VfONITORING REPORTS
DOG DATE
❑ aolq
YYYYMMDD

May 17, 2019
NCDEQ Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 7 — Period 1
Stormwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
Baxter
REC, ii E®
MAY 2 3 Z��g
CENT? —t tit
ES
w SECTION
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Permit
NCG210028, Part 11, Section B. This report provides sample results for outfall STO-5. Outfall STO-6
was not sampled during this event and a separate report will be provided for that outfall. Sample values
are within benchmark limits. We will continue to monitor the outfalls as required.
If you have any questions regarding this report, please contact Corey Carpentier at 828-756-6636.
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 the 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.
Sincerely,
Corey Carpentier
EHS
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
Baxter Healthcare Corporation
PO Box 139D, Marion, NC 28752
T 828.756.4151

Stormwater Discharge Outfali (SDO)
Qualitative Monitoring Report
Forguidance on filling out thisform, please visit: jttp;./Zportal.ncdenr.orgliyehzlrinpdes-starmwaler/
Permit No.: /-Qj-0/.0/_/ or Certificate of Coverage No.:
Facility Name: 'Rgx-lrc yvad
County: _ Mt- bowe, /l Phone No. _ $Z�'^ 75-6 6 rSU
Inspector: u 4A1 --
Date of. Inspection: -
Time of Inspection: 12 , 3a pr►1
Total Event Precipitation (inches):____
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Ek les ❑ 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.
i
i 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
i
i 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;
{Signature of ermittee or
Page 1 of 2
SWU-242, Last modified 10/?S/2012

1. Outfall Description: 7
Outfall No. -1- Structure (pipe, ditch, etc.)
Receiving Stream: LA N
Describe the industrial activities that occur within the outfall drainage area:
p ,.. � ��- !I #.w,,. R,a • nr �4 h � '�,� o ,� K � s e �><A,lr.� S �.4..1 .E�P.•%�
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: /nas Z/w C /<,o
I Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): rD �✓G
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
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:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
�1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe ._ nIA
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Resources General Permit No. NCG120000
Date submitted 511712019
CERTIFICATE OF COVERAGE N0. NCG12 0 0 2 8
FACILITY NAME Baxter Healthcare
COUNTY McDowell
PERSON COLLECTING SAMPLES Rickey Styles
LABORATORY Baxter wastewater Lab Lab Cert. # 935
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2019
SAMPLE PERIOD ■❑ Jan -June ❑ July -Dec
or ❑ Monthly' (monthl
DISCHARGING TO CLASS ❑ORW ❑HQW *Trout ❑PNA
❑Zero -flow ❑Water Supply [:]SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period?z
Outfall No.
pate Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Chemical Oxygen Demand
Fecal Coliform
Total Suspended Solids
Benchmarks =__>
-
-
120 mg/L
1000 count per 100 mL
100 mg/L or 50 mg/0
STO 5
04/19/19
1
24
NA
1.00
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format "<XX m L" where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 11/1/2012-10/31/2017 SWU-248, last revised 10/25/2012
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 5o mg/L°
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier I, Tier 1, or Tier 3 responses. See General Permit text.
FOR PART AAND 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 0
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" reports) to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
5117119
(Date)
Permit Date: 11/1/2012-10/31/2017
SWU-248, last revised 10/25/2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted
CERTIFICATE OF COVERAGE NO. NCGn21_L iZ :
FACILITY NAME Rc1l�cTF� {.(���e-[X �;
COUNTY
PERSON COLLECTING AMPLES l-0Jc-k( ,
LABORATORY Agga Lab Cert. # C V 0 9
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 1 5^
SAMPLE PERIOD ❑ fan -June July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW RTrout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
[]Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
® No discharge this period?Z
Outfall No.
pate Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount
Inches;+
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks ===>
-
-
120 mg/L
100 mg/L or 50 mg/L4
�
� ' V' ©ilef-
AJ A-
A) 4
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
' See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L'; where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L4
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one coos of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitorina veriod
in the case of "No Discharge" reports) 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."
re of Permittee}
1. 1►3'f�c
/ {Date}
Permit Date: 8/1/2013-7/31/2018
SWU-245, last revised 7/31/2013
Page 2 of 2

a�rr
Baxter
January 13, 2016
NCDENR Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 3 — Period I
Stonnwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Pennit, fart
I1, Section B. There were no measurable storm events during this reporting period as defined by the
General Pen -nit Part 11, Section B.
If you have any questions regarding this application, please contact Mike Pisank at (W) 828-756-6017
or michael pisarik c ,baxter.com .
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 the 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 infonnation including the possibility of fines and imprisonment for
knowing violations.
Sincerely,
9(�A lan Weiler
Plant Manager
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
Baxter Healthcare Corporation
PO Box 1390. Marion. NC 28752
T 828.756A151

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 0 -7 Z�Z 15
CERTIFICATE OF COVERAGE NO. NCG21 d O 'Z g
FACILITY NAMEe.—
COUNTY rll,v w
PERSON COLLECTING SAMPLES
LABORATORY B , LC � arrLab Cert. # 4( OD 9 3 S
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR Q I J
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' _ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW Trout ❑PNA
❑Zero -flow []Water Supply ❑SA
RECEIVED []Other
JUL 2 9 2015 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is requirpmWAgNpy stares exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.) C====
No discharge this period?' T==20
Flipq
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches;
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =__>
_
-
120 mg/L
100 mg/L or 50 mg/L°
as � ,8 e .'lam.;
�i �
N ,
N�-
/►� �
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
' See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format. "<XX mg1L" where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/0
LA
)% A
%
A
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART AAND 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Moil an oriainal and one covv of this DMR. including all "No Discharae" reports, within 30 days of receipt of the lab results for at end of monitoring veriod
in the case of_"No Discharge" reports? 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,
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
.,
re of Permittee)
Permit Date: 8/1/2013-7/31/2018
7/ z+ rE-
(Date)
SWU-245, last revised 7/31/2013
Page 2 of 2

.4 Baxter
July 24, 2015
NCDENR Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 2 — Period 2
Stormwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
RECEIVED
JUL 2 9 2015
CENTRAL FILES
DWR SECTION
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Permit, Part
11, Section B. There were no measurable storm events during this reporting period as defined by the
General Permit Part II, Section B.
If you have any questions regarding this application, please contact Mike Pisarik at (W) 828-756-6017
or michael [e-mail] .
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 infonnation submitted. Based on my inquiry of the person or persons who manage the
system, or the persons directly responsible for gathering the information, the infonnation submitted is, to
the best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant
penalties for submitting false information including the possibility of fines and imprisonment for
knowing violations.
Sincerely,
Alan Weiler
Plant Manager
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
Baxter Heafthcare C=OratiOn
PO Box 1390, Maricn, NC 28752
T 828.756.4151

Baxter
August 29, 2018
NCDEQ Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 6 — Period 2
Stonnwater Discharge Outfall Monitoring; Report
Baxter Healthcare Corporation
Enclosed is the semiannual SDO monitoring report as required by the General Stonnwater Permit
NCG210028, Part 11, Section B. Sample values are within benchmark limits. We will continue to
monitor the outfalls as required.
If you have any questions regarding this report, please contact Corey Carpentier at 828-756-6636.
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 the 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.
Sincerely,
C ey Carpentier
EHS RECE/vEo
SEP 0 4 z018
Enclosures: Semiannual DMR (Original + Copy) �'C-Nrfi/,
UwR SF���QnS
Cc: Rick Styles
f3axtor I lealthcare Corporation
PO box 1390, Marion, NC 28752
T 828.756.4151

��
OEM
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit; bttn:lfyc2LIal.ncdenr org/)meh/lr(nades-stormwaterl
Permit No.: lY/IC/G/- 2/ G/ o/
Facility Name:
County: Trail C ,2 o//
Inspector: , 72,
Date of Inspection:
Q/-Q/ or Certificate of Coverage No.:
-ore ivooal AO1Z,-v.
Phone No. SL
Time of Inspection: _ 5M
Total Event Precipitation (inches): & , 6
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
[f],-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.
f 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 thye report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
Pagel of 2
SWU•242, Last modified 10/25/2012

I. Outfal Description:
Outfall No. Structure (pipe, ditch, etc.) wed ,ally a
Receiving Stream: u
Describe the ind strial activities that occur within the outfall drainage area:
G Ff `It a 1p
Qd
2. Color: Describe the color of the dischar a using bast colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L i9 h %? �ydi�=
3. Odor: Describe any di§tinq 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:
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:
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:
10 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
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 f�l7P{%L D,U, , 1` 1 '4if
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
SVM-242, Last modified 10/25/2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Resources General Permit No. NCGO60000
CERTIFICATE OF COVERAGE NO. NCG06_ 0 :b 0
FACILITY NAME Baxter Healthcare
COUNTY McDowell
PERSON COLLECTING SAMPLES David Blackwell
LABORATORY Baxter. Wastewater Lab
Lab Cert. # 935
Part A: Stormwater Benchmarks and Monitoring Results
Date submitted August 29, 2018
SAMPLE COLLECTION YEAR 2018
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? RYES ❑■ NO
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
Total event rainfall 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 Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
Soo
1
08/03/18
14A
NA
16
NA
NA
NA
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 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.
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 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 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 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 lab results for at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
08/2812018
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.or /web/wg/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18. 2012
Page 2 of 2

;--- . `P�
ROY COOPER
Governor
�`' Via; '^'�' :•�;����i
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. Brian Van Gelder
Boise Cascade Wood Products, LLC
306 Corinth Road
Moncure, NC 27559
MICHAEL S. REGAN
Secreteu-•
WILLIAM E.(TOBY) VINSON, JR,
Interim Director
May. 31, 2018 . RECEIVED
JUL 12 2018
CENTRAL FILE
DVIR SECTION'
Subject: NPDES Storm«ater Compliance Evaluation Inspection
Certificate of Coverage No. NCG210033
Boise Cascade Wood Products, LLC
Chatham County
Mr. Van Gelder
Staff from the Department of Environmental Quality (DEQ) conducted a stormwater inspection
on May 18, 2018, at your facility located at 306 Corinth Road in Lee County. The assistance
provided by yourselfduring the inspection was greatly appreciated. The inspection report is
attached and the findings during the inspection were as follows:
1. Certificate of Coverage (COC) No. NCC210033 was issued to Boise Cascade Wood
Products, LLC. to discharge stormwater runoff to the Haw River, a Class WS-IV
river; in the Cape Fear River Basin. Please include a copy of the COC in your
Stormwater Pollution Prevention Plan.
2. The facility has developed and implemented a stortnwater pollution prevention plan
(SPPP). A review of the plan indicated that it included all components required by the
general permit but there are preventive maintenance and good housekeeping
obligations that should be implemented with a routine inspection plan implemented.
Please he sure to adhere to all requirements of the stormwater permit with close
attention to the preventive maintenance and good housekeeping portion as noted
in the inspection report.
3. Semi-annual qualitative and analytical monitoring has been conducted at stormwater
discharge outfalls (SDOs), as required by the General Permit. The analytical results
State of North Carolina I Environmental Quality I Energy, Nlineral, and Land Resources
Raleigh Regional Office 1 1628 1 461 Service Center I Raleigh, NC 27609
919 791 4200

at all outfalls have been alternately above the permitted benchmark for TSS and
COD with some high readings for oil & grease at the vehicle maintenance area
for the last few years which has led to the facilities Tier three status and
sampling protocal. As such the facility is required to follow the guidelines as
spelled out in the Storm Water permit. Please provide the requested Tier Three
notification document requested in the inspection report.
4. All but.SDO #2 were observed and found accessible. Please provide the requested
clarifications concerning outfall #2 located on the SE corner of the property that
discharges to the Haw River. We suggest sampling SDO #2, if possible, at the
next sample event and provide findings and esults.
Please respond in writing to DEQ Raleigh Regional Office regarding Items 3 & 4 within 30
days of receipt of this letter. If you have any questions regarding the attached report or any of
the findings, please contact Thad Valentine at 919-791-4200 {or email:
thad.valentine c nederingov}.
Sincerely,
- Ja
Thad Valentine
Environmental Senior Specialist
NC Dept. of Environment Quality
Division of Land Resources
Raleigh Regional Office
Enclosure: Compliance Evaluation Inspection Form
cc: Central Files
RRO SWPIStormwatcr Files
Nothing Compares_
State of Pqf rth Carolina I Environmental Quality I Encrdy. Mineral and Land Rcsources
512 N. Salisbury Strect 1 1b12 41all Ser.vlce Ccnrer I Raicigh. North Carolina 2701) 1612
919 707 9200

Compliance Inspection Report
Permit: NCG210033 Effective: 08/01/13 Expiration: 07/31/18 Owner: Boise Cascade Wood Products L L C
SOC: Effective: Expiration: Facility: Boise Cascade Wood Products, LLC
County: Chatham 306 Corinth Rd
Region: Raleigh
Moncure NC 27559
Contact Person: Brian W Van Gelder Title: Phone: [phone]
Directions to Facility:
US 1 South to Old US 1. Right at bottom of ramp. Left on Corinth Rd. Facility address is 306, on the right.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 05/18/2018 Entry Time: 10:OOAM Exit Time: 01:OOPM
Primary Inspector: Thaddeus W Valentine Phone:
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Timber Products Stormwater Discharge COC
Facility Status: Compliant Not Compliant
Question Areas:
storm Water
(See attachment summary)
Page: 1

Permit: NCG210033 Owner - Facility: Boise Cascade Wood Products L L C
Inspection Date: 0511812018 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
It was noted that the log spray pond has overflowed in the past (1998 & 2000) that problem has not been noted since. We
recommend that the facility review the designed dimensions of the pond for that drainage area and check the pond depth and
dimensions to verify that the pond will still contain the required storm event. If those dimensions aren't available please have
that recalculated.
Please provide the Tier III notification document that was reportedly submitted in 2012, Our records do not indicate that we
recieved a notification nor what steps have been taken to try to lower the readings.
The area around the Hyster Shop indicated that proper preventive maintenance and Good Housekeeping measures are not
being followed and the site inspection procedures are inadequate. Oil is being stored in open containers exposed to the
weather and oil spill cleanup is not occuring in a timely manner. Oil absorbent booms and pads located at the drop inlet next
to the shop and before the oil water seperator are old and oil stained. Likewise,the absorbent pads in the rock lined
ditcK which conveys runoff from the oil water seperator to the outfall are old and stained. Please properly train your
employees in proper preventive maintenance and good housekeeping practices in this area and employ an effective
inspection schedule for this and all other areas at the facility.
Our records that a compliance inspection was performed in December 2012 and the site contact notified the inspector that
outfall #2had not discharged since 2008. In May of 2014 Steven D. Weber with Parker and Poe obtained samples from
outfall #2 that exceeded the benchmark values and was in tier II as required by the permit. Please begin sampling outfall #2
once again or provide justification for not doing so.
Please provide all requested documentaion and responses as requested within 30 days of the reset of the inspection report.
Additionally, immediately implement any addion actions or inspections to insure this facility remains in compliance.
Page: 2

Permit: NCG210033 Owner - Facility: Boise Cascade Wood Products L L C
Inspection Date: 05/18/2018 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Stormwater Pollution Prevention Plan
Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
N ❑ ❑ ❑
# Does the Plan include a General Location (USGS) map?
e ❑ ❑ ❑
# Does the Plan include a "Narrative Description of Practices"?
E ❑ ❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
E ❑ ❑ ❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
E ❑ ❑ ❑
# Has the facility evaluated feasible alternatives 10 current practices?
0 ❑ ❑ ❑
# Does the facility provide all necessary secondary containment?
N ❑ ❑ ❑
# Does the Plan include a BMP summary?
® ❑ ❑ ❑
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
® ❑ ❑ ❑
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
0 ❑ ❑ ❑
# Does the facility provide and document Employee Training?
0 ❑ ❑ ❑
# Does the Plan include a list of Responsible Party(s)?
® ❑ ❑ ❑
# Is the Plan reviewed and updated annually?
0 ❑ ❑ ❑
# Does the Plan include a Stormwater Facility Inspection Program?
■ ❑ ❑ ❑
Has the Stormwater Pollution Prevention Plan been implemented? i ❑ ❑ ❑
Comment: Recommend placing a copy of the feasability study and the SP3 and locating a copy of the
Certificate of Coverage and including that in the SP3 plan. It is a requirement of the permit to
have a copy of the Certificate of Coverage at the facility. This certificate has the general permit
number that is unique to your facility with your aenral permit #NCG210033.
Qualitative Monitorinq Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? e ❑ ❑ ❑
Comment: Provided
Analytical Monitoring Yes No NA NE
Has the facility conducted its Anatytzal monitoring? 0 ❑ ❑ ❑
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ® ❑ ❑ ❑
Comment: The analytical data was available and it indicates that there are exceedances for COD, TSS and
oil and grease during alternative sampling periods.
Permit and Outfalls
Yes No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ❑ ! ❑ ❑
# Were all outfalls observed during the inspection? ® ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division? ❑ ❑ ❑
# Has the facility evaluated all illicit (non stormwater) discharges? ® ❑ ❑ ❑
Comment: The facility didn't have a copy of teh COC available
Page: 3

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. Brian Van Gelder
Boise Cascade Wood Products, LI-C
306 Corinth Road
Nloncurc, NC 27559
Mr. Van Gelder:
ROY COOPER
Goref71W'
MICHAEl- S. REGAN
Sec•relrtr'v
W11-1-IANI E.(TOBY) VINSON, JR.
Interim Direcmr
RECEIVE D
June 7, 2018 JUL 12 2018
CENTRAL FILE,
DWR SECTION
Subject: NPDI"S Storniwater Permit
Permit No. NCG210033
Representative Oii(f ill Status Requesf
Boise Cascade Wood Product, LLC
Chatham County
The Raleigh Regional Office staff have reviewed your request dated April 24, 2018 for a determination
that stonnwater discharge outfall (SDO) 001 be granted representative outfall status for SDO 003 and SDO
004 &. 005 be granted representative outfall status for SDO 006. After detailed review of all analytical
data, site maps and a walktlirouI'h of' the site, we found that although some of the drainage areas have
similar characteristics, none of the sample data for any of the SDO's are consistent or representative of any
other SDO. "Therefore;, the request for representative outfall status is disapproved. You are to continue
sampling all outfalls as required by the permit under the tier three sampling requirements.
Please append this letter to your Stormwater Pollution Prevention Plan (SI'l'P) or permit to document that
representative outfall status has been disapproved. If changes in drainage areas, structures, processes,
storage practices, analytical results or other activities occur that significantly alter the basis of this
disapproval, a representative outfall status request may be revisited. Resume sampling at all SDO'S or
reapply to this office for representative outfall status based on updated information. If you have any
questions or comments concerning this letter, please contact me at [phone] or at
thad.valentine a ncdenr. Gov.
Sincerely,
William 11. Denton, 1V, PE
Regional Supervisor-RRO
ce: Raleigh Regional Office
Central Office/Stormwater Permittinu Unit
Central Files
State of North Carolina I I nvironmental Quality Energy, Mineral, and Land Resources
Raleigh Regional Office 1 1628 Mail Service Center j Raleigh, NC 27609
919 791 4200

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000 NC6,, 21 p p 33
RECEIVE n,
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPp. JUL 0 5 Z018
C!ENTPrtt. FILE'
Facility Name: _Moncure Plywood,
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 4
Outfall No. _1_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COO (mg/l)
TSS (mg/1)
-
Date Sam le
C
Collected,
mm/dd/yy
7
v.
z
F ;`f
2�
t p 4
y4
y;
tit
ip
f
05/31/18
.81
98
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4
Outfall No. 3
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg11)
TSS (mg1l)
Date Sample
Collected,.
mmlddlyy
Yss
V
4
3
5131118
.81
460
SWU-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. _4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/1)
TSS (mg/1)
O & G (mg/1)
Date Sample
Collected,
mmlddlyy
a
5131118
.81
320
SW U-264-Generic-13 Dec2012

Additional Outfall Attachment
Outfall No. _6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, {units
Total
Rainfall, -
inches
Benchmark
N/A
COD (mg/1)
TSS (mgll)
O 8 G (mg/1)
Date Sample
:`
d
Collected,
w�
mmlddlyy
05/31/18
.81
85
SWU-264-Generic-13Dec2012

I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
sg�jstern 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."
Signa
Date
For questions, contact your local Regional Office:
DWQ Rectional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFFICE
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 7I4
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
} — 'To preserve, prvleC
' and enhance
North Carolina's water _. "
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000 N Cyr 3 3
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4
Outfall No. T1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD {mg/I)
TSS (mg/I)
Date Sample
Collected,
mmlddlyy
04/16/18
3.17
540
SW U-264-Generic-13 Dec2012
�- ti

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood_
County.- _Chatham
Phone Number: (_803_)_385-4957
Outfall No. _3_
Total no. of SDOs monitored 4
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ® No ❑
Yes ® No ❑
Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
..
-
Benchmark
N/A
COD (mg11)
TSS (mg1l)
Date Sample
Collected,
mmlddlyy
E========
4/16118
3.17
610
SW U-264-Generic-13 Dec2012

Additional outfall Attachment
Outfall No. �4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
NIA
I COD (mg/I)
TSS (mg/1)
O & G (mg11)
Date Sample
Collected,
mmlddlyy
4116118
3.17
27
5W U-264-Generic-13 Dec2012

Additional Outfall Attachment
outfall No. 6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg11)
TSS (mg11)
O & G (mg11)
Date Sample
Collected,
mmlddlyy
��
M
M
M
M
M
M
M
M
04/16/18
3.17
150
SWU-264-Generic-13Dec2012

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 .AUX
A��4_A__Z_&
Date-,�i-1$
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
- — 2090 US Highway 70
Swannanoa, NC 28778
[phone]
I-R_AL_EIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFF_
585 Waughtowri Street
Winston-Salem, NC 27107
[phone] J
(ETTEVILLE REGIONAL OFF
225 Green Street
Systel Building Spite 714
Fayetteville, NC 28301-5043
[phone]
►SHINGTON REGIONAL OFFI
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
vlOORESVILLE REGIONAL OFFIC:
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
'To preserve, protect
and enhance
North Carolina's water..."
SW U-264-Generic-13 Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or k66 o 0 33
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood RECEIVED
County: _Chatham APR 10 zum
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4 CENTRAL FILES
uvv m OtU I ION
Outfall No. 1
Is this outfali currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark N/A COD (mg11) TSS (mg/1)
z
Date Sample
Collected,
mmlddlyy
3122/18 .76 100
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood.
County: :Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 4
Outfall No. 3_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter. [units
SWU-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. ,4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
I COD (mg11)
TSS (mg/1)
O & G (mg11)
Date Sample
Collected,
mmlddlyy
3/22/18
.76
21
SW U-264-Generic-13Dec2Q12

Additional Outfall Attachment
Outfall No. _6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD (mg/1)
TSS (mg1!)
O & G (mg1!)
Date Sample
Collected,
mmlddlyy
MMMMMMMMM
3/22118
.76
83
SWU-264-Generic-13Dec2012

" I certify, under penally 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."
Sigi
Dat
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
-.---_____209(IYtJS f-lighwav 70 -
S%vannanoa. NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3900 Barrett Drive
Raleigh. NC 27609
[phone]
WINSTON-SALEM REGIONALOFFICE,
585 Waughtown Street
Winston-Salem. NC 27107
(3 6) 771-5000
_FAYETTEVILLE REGIONAL O FICE._
225 Green Street
Svstel iitulding Suite 714
Favetteville. NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington. NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Centcr
Raleigh, NC 27699-1617
[phone]
-MOORESVILLE_RE[:IONAL-OFFICE- -- -
610 I ast Center Avenue/Suite 301
Mooresville., NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Fxtensicm
k ilminglon. NC 29405-2845
[phone]
"To preserve: ptntect
and enhance
Notih Carolina's .vater...
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or O MqR Z
Certificate of Coverage (COC) No. NCG210000 J C fir- A 1
eFN ZoIB
ow" �C@
This monitoring report summary of the calendar year should be kept on file on -site with the,facllity-`SPPP.
Facility Name: _Moncure Plywood
County: ,Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored _4
Outfall No. 1_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was month ly.monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SW U-264-Generic-13 Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4
Outfall No. �3_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other _ ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SW U-264-Generic-13 Dec2012

Additional Outfall Attachment
Outfall No. ,4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD (mg/1)
TSS (mg/l)
O & G (mg/1)
Date Sample
Collected,
mmlddlyy
MMMMMMMMM
2/28118
No Flow
SWU-264-Generic-1 Mec2012

Additional Outfall Attachment
Outfall No. 6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
I COD (mg/I)
TSS (mg/!)
O & G (mg/lJ
Date Sample
Collected,
mm/ddlyy
2/28/18
No Flow
SWU-264-Generic-13Dec2012

"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 pos ability of
Signature
Date -1/z3
and imprisonment for knowing violations."
For questions, contact your local Regional Office:
DW Regional Office Contact Information:
E_ VILLE REGIONAL OFF
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RAL_ EIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
W_IN_ST_O_N-SALEM_REGIONAL OF_I
585 Waughtown Street
Winston-Salem, NC 27107
336) 771-5000
FAYETTEVILLE REGIONAL OFFICI
225 Green Street
Systel Building Suitc 714
Fayetteville; NC 28301-5043
[phone]
WASHINGTO_N REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOO_RESV_ILL_E REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
W_ I LM I_NGTON _REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To preserve, prolecl
and enhance
North Carolina's svaler..,"
SW U-264-Generic-13 Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDFS Permit No. NCS❑❑❑❑❑❑ or � ] -3 0
Certificate of Coverage (COC) No. NCG210000 fV �G"'� a
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood.
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 4
Outfall No. _1^
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑ ppcc
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑ r�CC1����
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued? AfAR 0 7 2018
Enough consecutive samples below benchmarks to decrease frequency ❑ CC-N7-Ir
Received approval from DWQ to reduce monitoring frequency ElCWRk SECT DES
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (un
Total
Rainfall,
inches
Benchmark N/A COD (mg1l) TSS (mg/1)
Date Sample
Collected, a
{
mmlddlyY
1128/18 1.03 89 53
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood.
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 4
Outfall No. �3�
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark NIA COD (mg/1) TSS (mg/!)
Date Sample -
Collected,
mm/dd/yy
1 /28/18 1.03 390 57
SW U-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. _4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units
Total
Rainfall,
inches
Benchmark N/A • COD (mg/1) TSS (mg/1) O & G (mg1!)
Date Sample'
Collected,
mmlddlyy y r
1/28/18 1.03 100 53 15.9
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2018
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood.
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 5
Outfall No. _5_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark N/A COD (mgly TSS (mgly
Date Sample.
Collected,
mm/ddlyY a
1128/18 1.03 140 34
SWU-264-Generic-13Dec2012

Additional Outfall Attachment
Outfali No. _6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/1)
TSS (mgA)
O & G (mg/1)
Date Sample
Collected,
mmlddlyy
1128118
1.03
120
16
SWU-264-Generic-13Dec2012

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 eval6ate 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."
7 f7
Signature
Date Z/'zo/2org
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFFICE
585 Waug.htown Street
Winston-Salem, NC 27107
[phone]
FAYETTEVILLE REGIONAL.OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL_OFFICE
943 Washington Square Mail
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
(704) 663- 1699
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To preserve, protect
and enhance
North Carolina's water... "
SWU-264-Generic-13Dec2012

f I
Boise Cascade
M011CUre P1
December 15, 2017
Attention: Central Files
NC Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Plant
CERTIFIED MAIL / RETURN RECEIPT REQUEST
Re: Moncure Plywood
NPDES Permit: NC0023442
Moncure, Chatham County, NC
7016 2710 0000 7767 2814
PC&")JOOa3
306 Corinth Rd
Moncure, NC 27559
M9)•542-231 i
FAX [phone]
This letter is sent in regard to the storm water DMR for November 2017 in accordance with NPDES permit NCG210000. If
additional information is required, please contact me at [phone].
Sincerely,
00 �'A
Brian Van Gelder
Moncure Plywood
[phone]
JAN 02 2018
U'Pl;'. CECTION
VFORMAMN PROCESSiMG UNIT

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 4
Outfall No. % 1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® ..No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark N/A COD (mg/l) TSS (mg/1)
Date Sample
A,
Collected
,
s
mmlddlyy `
11/13/17 1.01 110 15
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4
Outfall No. _3_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units
SW U-264-Generic-13 Dec2012

Additional Outfall Attachment
Outfall No. —4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/1)
TSS (mg/1)
O & G (mg/l)
Date Sample
Collected,
mmlddlyy
11/13/17
1.01
44
7.2
7.42
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood.
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 5
Outfall No. _5�
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ® No ❑
Yes ® No ❑
Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/l)
TSS (mg/!)
Date Sample.
Collected,
mmlddlyy
.tQ
.< .. ._,.��
.....-..., .ram
x x
e
i
2 r
,: Ff`� -
-.' •Y�..
� .r' i. Yp�^�,
#
i r,. +�'�Y+:r
ri}1!
4
11/13117
1.01
91
18
SW U-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. ,6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units
Total
Rainfall,
inches
Benchmark N/A COD (mg/1) TSS (mg/!) O & G (mg/1)
Date Sample
Collected,
mmtddlyy
11/13/17 1.01 72 5.2
SWU-264-Generic-I3Dec2012

"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_ 1 am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
Signature _
Date j 2-
For questions, contact your local Regional Office:
DWO Regional Office Contact information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
(919) 791 A200
WINSFON-SALEM RECIONALOFFICE
585 Waughtown Street
Winston-Salem, NC 27107
(33-6) 771-5000
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
y CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVI LLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Moorem ille, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2945
[phone]
Abah CaC&M-S ► war.
SWIJ-264-Generic-1 aDec2o12

December 4, 2017
NCDEQ Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 5 — Period 1
Stormwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
Barer
RECEIVED
DEC 1 1 2017
CENTRAL FILES
DWR SECTION
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Permit
NCG210028, Part 11, Section B. We will continue to monitor the outfalls as required.
If you have any questions regarding this report, please contact Corey Carpentier at 828-756-6636.
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 the 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.
Sincerely,
Core Carpenti
EHS
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
Baxter healthcare Corporation
110 Box 1390, Marion, NC 28752
1' 828.756.4151

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit; htW f 1p=l.ncdenr.orglweb/lr node -sto mwater/
Permit No.: N&//
Facility Name:
County: A.
Inspector:
Date of Inspection:
Time of Inspection:
or Certificate of C verlge No,: N/C/�o/�d�D���
Pr
Total Event Precipitation (inches):
Z /(
X2-y- 7` 3 C- - v/ 5 7
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 i
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 avvroval from the local DWQ Reizional Office.
By this signature, I certify thatthis report is accurate and complete to the best of my knowledge:
c
(Signature of Permittee or Designee)
Page 1 of 2
SWU-242, Laastmodifed 10/25/2012

t
1. Outfall Description:
Outfall No. Structure (pipe, ditch, etc.) , et
Receiving Stream:
Descri a the i ustrial activities that ccur within the outfall drainage area:
�u��► « a rep�c�c7�r�e 57�r� e -
2. Color: Describe the color of the discharge using basic colors gd, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: ✓ /
3. Odor: Describe any di tinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): 1111k
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
` 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:
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:
QJ 2 3 4 5
i. ' Is there any foam in the stormwater discharge Yes I�1
j 8. Is there an oil sheen in the stormwater discharge? Yes
4. Is there evidence of erosion or deposition at the outfall? Yes 6D
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
SWU-242, Last modified 10/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted
CERTIFICATE OF COV GE NO. NCG21 _0 Z
FACILITY NAME
COUNTY A c.
PERSON COLLECTING SAMPLES „? �jlic�klvl
LABORATORY Lab Cert. # N COO If 3
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
[]Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period ?7
C+utfaEl No.
Hate Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =__>
-
-
120 mg/L
100 mg/L or 50 mg/L4
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format. "<XX me/L where XX is the numerical value of the
detection limit, reporting limit, etc, in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Trer 2, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018
5WU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ===> I
-
-
15 mg/L
100 mg/L or 50 mg/O
N
A
/t
Alit
ALI-
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, rer 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 11 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one coon of this DMR. includina all "No Discharae" reports. within 30 days of receipt of the lab results (or at end of monitoring period
in the case of "No Discharae" reports) 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."
/Z-u-Zv�7
(Date)
Permit Date:8/1/2013-7/31/2018
SWU-245, last revised 7/31/2013
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑u❑❑ or
Certificate of Coverage (COC) No. NCG210000 !'JC C a / o (D 33
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood RFCEIVED
County: Chatham DEC 0 5 201
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored
Outfall No. _1_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg11)
TSS (mg/1)
Date Sample
Collected,
mmlddlyY
10131/17
No Flow
SW U-264-Generic-13 Dec2012

Individual NPDES Permit No
Certificate of Coverage (COC) No.
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
NCS❑❑❑❑❑❑ or
NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4
Outfall No. 3_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/l)
TSS (mg11)
Date Sample
Collected,
mmlddlyy
10/31/17
No Flow
SW U-264-Generic-13 Dec2012

Additional Outfall Attachment
J Outfall No. _4
1 Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
NIA
COD (mgll)
TSS (mg/1)
O & G (mg/1)
Date Samplesnj
Collected,
uµ°.
mmlddlyy
10/31/17
No Flow
SW U-264-Generic-13 Dec2012

Additional Outfall Attachment
Outfall No. �6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, {units)
Total
Rainfall,
inches
Benchmark NIA COD (mgll) TSS (mg1l) O & G (mg/l)
Date Sample
Collected,
mmlddlyy
10/31/17 No Flow
SW U-264-Generic-13 Dec2012

"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 ��L(•���4X
Date i i - 2-9 - ;�O k 1
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIG14 REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFFICE
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
- "To preserves, protect
aad en"tioe
JUorth GarnWm s water._ . "
SW U-264 -Generic-13Dec2012

Boise Cascade
Moncure Plywood Plant
CERTIFIED MAIL/ RETURN RECEIPT REQUEST
7016 2710 0000 7767 2784
November 4, 2017
Attention: Central Files
NC Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Moncure Plywood
NPDES Permit: NCO023442
Moncure, Chatham County, NC
306 Corinth Rd
Moncure, NC 27559
(919)-542-2311
FAX [phone]
N/ C (, a 100 -3-3
This letter is sent in regard to the storm water DMR for,0d A�20 7 in accordance with NPDES permit NCG2I0000, If
additional information is required, please contact me at [phone].
Sincerely
N'N
Brian Van Gelder
Moncure Plywood
[phone]

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: L803J_581-9261 Total no. of SDOs monitored 5
Outfall No. �1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Total
Rainfall,
inches
Parameter,((units)
Benchmark .
' N/A
COD (mg/1)
7ss (mg/1)
Date S ample
Collected,
5
r,
9130117
No flow
SW U-264-Generic-13 Dec2012

k'a
Additional Outfall Attachment
Outfall No. _3
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval From DWQ to reduce monitoring'frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Total
Rainfall,
inches
Parameter,.tunitsj
Benchmark
WA
COD (mgR) _
TSS (mg/l)
O & G (mg/1)
Date Sample
Gallected
mmlddlyy
r✓. yw..�.,�
t aL w...
E
W
-
9130117
No Flow
SWU-264-Generic-131)ec2412

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCSUU[_JL [_J" or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: Chatham
Phone Number. L803J 581-9261
Outfalf No.
Is this outfall currently in Tier 2 (monitored monthly)?
Total no. of SDOs monitored 5
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 fast year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ® No ❑
Yes ® No ❑
Yes ❑ No
Total
Rainfall,
inches
Parameter, (units)
Benchmark
N/A
COD (mg/I)
TSS (mg/l)
Date Sample
Collected,
mtnlddlyy
z
9130117
No flow
SWU-264-Generic-1 Mec2012

Additional Outfall Attachment
Outfall No. _6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter
Total
Rainfall,
inches
Benchmark N/A COD (mgll) TS5 (mg/1) O & G (mg/!)
Date Sample -
Collected, _ ; -
mmlddlyy-
9130197 - - - - - - No Flow
SWU-264-Generic-13Dec2012

"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 qualfied 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 olkudLezdALJ_a�
^^
Date R - O 1 ' X011
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WLNSTON-SALEM REGIONAL OFFICE
585 Waughtow-n Street
Winston-Salem, NC 27107
[phone]
FAY_ E,TTEVIL E';REGIONALOFF_ICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINdTON REGIONAI:OFFICE
943 Washington Square Mail
Washington, NC 27889
[phone]
OENTRAL BMr,.g
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLEREGIO�iAL OF_FiCE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILM INGTON,REGIONAL.OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
I "To peww, pmf�
I � end ��oe
North Camflm,$ fir...
SW U-264-Generic-13 Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000 tvc r- I:z t00 3j
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County. _Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4
Outfall No. `1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
R CEIVED
OCT03Z 17
CEN7TRAL fiILE
Lam, SEC�'
T"ON
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored _4_
Outfall No. _3
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD {mg/1}
TSS (mgll)
Date Sample:
Collected,
mmlddlyy
;s
n
V�
8131/17
No Flow
SWU-264-Generic-13Dec2012

Additional outfall Attachment
Outfall No. 4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD (mg/1}
TSS (mg/1}
O & G (mg/!}
Date Sample
Collected,
mmlddlyy
0
M
M
M
8l31/17
No Flow
SWU-264-Generic-13Dec2012

Additional outfall Attachment
Outfall No. —6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Total
Rainfall,
inches
Parameter, (units)
Benchmark
N/A
CoD (mg/I)
TSS (mgly
O & G
Date Sample
Collected,
mm/dd/yy
MMMMMMMMM
8I31/17
No Flow
SW U-264-Generic-13Dec2012

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 possniof fines a
j
Signature _ ti1
Date q/u-,
imprisonment for knowing violations."
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE i FAYETTEVILLE REGIONAL OFFICE MOORESVILLE REGIONAL OFFICE
2090 US Highway 70 225 Green Street 610 Fast Center Avenue/Suite 301
j Swannanoa. NC 28778 f Svstel building Suite 714 Mooresville, NC 28115
[phone] Fayetteville, NC 28301-5043 [phone]
[phone]
RALEIGH REGIONAL OFFICE ! WASHINGTON REGIONAL OFFICE WILMINGTON REGIONAL OFFICE
3800 Barrett Drive 943 Washington Square Mall 127 Cardinal Drive Extension
Raleigh, NC 27609 'i Washington. NC 27889 Wilmington, NC 28405-2845
[phone] (252) 946-648 f [phone]
WINSTON-SALEM REGIONAL OFFICE CENTRAL OFFICE
1 585 Waughtown Street 1617 Mail Service Center
Winston-Salem, NC 27107 Raleigh. NC 27699-1617
[phone] [phone]
"To preserve, protect
and enhance
North Carolina's water.."
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCSW❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000 rd 3 3 This monitoring report summary of the calendar year should be kept on file on -site with the facility'—RECEIVED
RECEI /LD
AUG
Facility Name: _Moncure Plywood ^.NTRI,L ���
County: TChatham - t�R FILES
` S�r�(nq
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4
Outfall No. _1_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 {monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg1l)
TSS (mgll)
Date Sample
Collected,
mmlddlyy
sz 2�.S+.T--.
-.,..,.. -, 73,.. .F!'�lt-
7t. s-
-iR x. $3.. �1 'r
S�fd'r'' Is hM - •�sf'.�"
"�- -;fi ,.M ��hSA".s'a
f.r�>
•.fi'Y� b'\"Yr
`�, .��+E;�r.
7/31/17
No Flow
SWU-264-Generic-I3Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
~ Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood.
County: Chatham
Phone Number: (_803_)_385-4957
Outfall No. _3_
Total no. of SDOs monitored 4
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ® No ❑
Yes ® No ❑
Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/q
TSS (mg/1)
Date Sample
Collected,
mmlddlyY
7/31/17
No Flow
SWU-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. 4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough 'consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD (mg/I)
TSS (mg/!)
O & G (mg/!)
Date Sample
Collected,
mmlddlyy
MMMMMMMMM
7/31117
No Flow
SW U-264-Generic-13 Dec2012

Additional Outfall Attachment
Outfall No. 6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmark to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
I COD (mg1!)
TSS (mg/1)
O & G (mg/1)
Date Sample
Collected,
mmlddlyy
MMMMIMMMMM
7/31/17
No Flow
SWU-264-Generic-13Dec2012

"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 possibilit of fines and imprisonment for knowing violations."
Signature
Date . _ ? Z 7V �f
For questions, contact your local Regional Office:
DWt�. Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICI
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
STON-SALEM REGIONAL OFFICE
585 Waughtown Street
Winston-Salem, NC 27107
336} 771-5000
FAYE_ TTEVILLE REGIONAL_ OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville. NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
VIOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To preserve, protect
and enhance
North Carolina's 3vater..."
SW U-264-Gene ric-13 Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000 AUG 4 7 2011
IV c t; :x I o 63,3 CENTRAL FILES
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP. DWR SECTION
Facility Name: _Moncure Plywood.
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored _4
Outfall No. �1____
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ® No ❑
Yes ® No ❑
Yes ❑ No
Total
inches
Mm/dd1yy
SWU-264-Generic-13Dec2412

Additional outfall Attachment
Outfall No. �6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SW U-264-Generic-13 Dec2012

"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 fjqes and imprisonment for knowing violations."
Signature ,g
Date ? -2 6 - IZ L
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highwa% 70
Swannanoa. NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
FAYETTEVILLE REGIONAL'OFFICI
225 Green Street
Systel Building Suite 714
Fayetteville. NC 28301-5043
_ [phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
WINSTON-SALEM REGIONAL OFFICE CENTRAL OFFICE
E 585 Waughtown Street 1617 Mail Service Center
Winston-Salem, NC 27107 F Raleigli, NC 27699-1617
[phone] i, [phone]
NOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville. NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To preserve, protect
and enhance
North Carolina's water... "
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY,DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood.
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 4
Outfall No. �3�
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark N/A coD (mg/!) TSS (mg/l)
Date Sample
Collected,
mmlddlyy
No Flow
SWU-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. _4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/1)
TSS (mg/1)
O & G
Date Sample
Collected,
mmldd/yy
No Flow
SW U-264-Generic-13Dec2012

"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
Signature
Date
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
r ASH EVILLEREGIONAL OFFIC
2090 US Highway 70
S,,vannanoa. NC 28778
! [phone]
- _ RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh. NC 27609
j [phone]
I WINSTON-SALEM REGIONAL OFFICE
i 585 Waughtown Street
Winston-Salem. NC 27107
[phone]
FAVETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
(910) 4-33-3300
WASHINGTON REGIONAL OFFICE_
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh; NC 27699-1617
[phone]
OOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To presence. protect
and enhance -
North Carolina's water..."
S W U-264-Generic-13 D ec2012

July 21, 2017
NCDENR Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 4 — Period 2
Stormwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Permit
NCG210028, Part 11, Section B. We will continue to monitor the outfalls as required.
If you have any questions regarding this application, please contact Mike Pisarik at 828-756-6618 or
michael [e-mail].
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 the 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.
Sincerely,
Brian Smit !�C
EHS Director
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
Baxter Healthcare Corporation
Po Box 1390, Marion, NC 28752
T 828.756,4151

I
,

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 0 -1 'Z
CERTIFICATE OF COVERAGE NO. NCG21 6 0 _�_
FACILITY NAME
COUNTY M
PERSON COLLECTING SAMPLES G .1 R
LABORATORY 13arl= y : Lab Cert. # NL OQ i3 5
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR .2 0 I %
SAMPLE PERIOD RJan-June ❑ July -Dec
or Lj Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW 5aTrout ❑PNA
[]Zero -flow ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
EZ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =__>
_
-
120 mg/L
100 mg/L or 50 mg/L
r�Ali
_2VAT
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they mutt be reported in the format. "<XX mg/L". where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L,
Note: 1f you report a sample value in excess of the benchmark, you must implement Tier I, Tier 1, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period?'
Outfal! No.
Date Sample
i
Collected
(mo/dd/yr)
24-hour rainfall
amoun3,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mgJL
100 mg/L or 50 mg/L
N
1V
N
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must Implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS, SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an origh al and one copy of this DMR ncludinn all "Na Dtscharne" enorts, within 30 days otec�ot of the lab results for at end of monitorina period
In the arse of "No Dlscharae" resorts) 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 tha - how are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of
Permit Date: 8/1/2013-7/31/2018
7-- z! -17
(Date)
SWU-245, last revised 7/31/2013
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or / � c c , a 33
Certificate of Coverage (COC) No. NCG210000 J�
This monitoring report summary of the calendar year should be kept on file on -site with the facility $PPP, R EC E wE D
Facility Name: _Moncure Plywood
JUL 0 3 2017
County: Chatham CENTRAL FILES
Phone Number: (_803J_385-4957 Total no. of SDOs monitored 4 DWR SECTION
Outfall No. 1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter. (units
SW U-264-Generic-13 Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4
Outfall No. �3
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter,((units)
Total
Rainfall,
inches
Benchmark N/A COD (mg/1) TSS (mg1l)
Date Sample
Collected,
mmlddlyy
05/24117 .97 1100
SW U-264-Generic-13 D ec2012

Additional outfall Attachment
Outfall No. 4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, On
SW U-264-Generic-13Dec2012

Additional Ootfall Attachment
Outfall No. _6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units
Total
Rainfall,
inches
Benchmark N/A COD (mg/1) TSS (mg/1) O & G (mg11)
Date Sample
x-
Collected,
mmlddlyy
05/24/17 .97 1120
SW U-264-Generic-1 Mec2012

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 4_X1
Date J-jN+� ZS'-% 2047-
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFFICE
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
FAYETTEVILLE REGIONAL_ OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
9l0) 433-3300
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh; NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
7o preserve, protect
and enhance
North Carolina's water...
SW U-264-Generic-13 Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
I Calendar Year 2017
Individual NPDES Permit No. NCSL
Certificate of Coverage (COC) No. NCG21
This monitoring report summary of the c
Facility Name: _Moncure Plywood_
County: ,Chatham
Phone Number: L803_)_385-4957
❑❑ or
year should be kept on file on -site with the facility SPPP.
Total no. of SDOs monitored _4
Outfall No. 1_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was ll monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehiclelmaintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/l)
TSS (mg/I)
Date Sample
C1
ollected f
mmlddl yY
-1�-- 1-
,, a
`
M{ � $ • 1
r. ' 44
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05124l17
.97
SWU-264-Generic-1 Mec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
ICalendar Year 2017
Individual NPDES Permit No. NCS❑
Certificate of Coverage (COC) No. NCG211
This monitoring report summary of the c
Facility Name: _Moncure Plywood.
County: _Chatham
Phone Number: (_803_)_385-4957
❑❑❑❑ or
year should be kept on file on -site with the facility SPPP.
Total no. of SDOs monitored ^4
Outfall No. 3
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No El
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below be lchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehiclelmaintenance activities? Yes ❑ No
Parameter, units
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/1)
TSS
ng/l)
Date Sample
cted,
Collet mmlddlyy
elr
v�
r;
Mwffl-
05/24/17
.97
1100
S W U-264-Generic-13 D e c2 012

Additional Outfall Attachment
Outfall No. —4 1
Is this outfall currently in Tier 2 (monitored monthly)? Yes 0 NOE]
Was this outfall ever in Tier 2 (monitored mo I nthly) during the past year? Yes N NOE]
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency F-1
Received approval from DWQ to reduce monitoring frequency F-1
Other I F-1
Was this SDO monitored because of vehicle Imaintenance activities? Yes M NOE]
Total
Rainfall,
inches
Parameter,(units)
Benchmark
NIA
COD (mg1l)
TSS (tngfi)
0 & G (mg/1)
Date Sample
Collected
mmidd/y
Q il-
N...
-'-'JRi L
M
!'
nnLk
uh,
p.
05/24117
.97
39
SWU-264-Generic-1 3 Dec2012

Additional Outfall Attachment
Outfall No. _6
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly)
If this outfall was in Tier 2 last year, why was
Enough consecutive samples below ber
Received approval from DWQ to reduce
Other
Was this SDO monitored because of vehiclelmaintenance
Yes ® No ❑
during the past year? Yes ® No ❑
monthly monitoring discontinued?
chmarks to decrease frequency ❑
monitoring frequency ❑
❑
activities? Yes ❑ No
Total
Rainfall,
inches
Parameter,
(units)
Benchmark
N/A
COD (mg1l)
TSS (rng/!)
O & G (mg1!)
Date Sample
Collected,
mmlddlyy
05/24/17
.97
120
SWU-264-Generic-1 Mec2012

"I certify, under penalty of law, that this docume
system designed to assure that qualified persor
or persons who manage the system, or those pi
best of my knowledge and belief, true, accurate
including the possibility of fines and imprisonme
Signature I / ""\, 4-1.1
Date j., Z0 7-, Z v+ ;t-
DWQ Regional Office Contact Information:
t and all attachments were prepared under my direction or supervision in accordance with a
iel properly gather and evaluate the information submitted. Based on my inquiry of the person
sons directly responsible for gathering the information, the information submitted is, to the
and complete. I am aware that there are significant penalties for submitting false information,
for knowing violations."
For questions, contact your local Regional Office:
ASHEVILLE REGIONAL OFF
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFIC
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL 01
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
(910)_433-3300
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
--- "To preserve, protect
and enhanoe
North Can:dina's;valer._."
SW U-264-Generic-13 Dec2012

WASTEWATER MANAGEMENT, L.L.C_.
P.O. Box 578 Pittsboro, N.C. 27312 [phone] [e-mail]
June 16, 2017
Brian Van Gelder,
Stormwater COD samples and data from outfalls 1, 3, 4, & 6 were collected
on 5-24-17 at Moncure Plywood. Lab data is attached. Flaw and visual
observations collected on -site are as follows:
Rainfall = 0.97" pL Std.= 7.02/24.2C Turbidity 20 ntu STD = 19.81 ntu'sd 735
Out all COD Flow PH
#1 @ 0910 310 mg1l 25 gpm 7.21 @ 28. 4C
43@ 0900
1100 mg1l
15 gpm
6.85 a 22. 7C
#40a 0850
39 mg1l
14 gpm
6. 75 a 21.6C
46@ 0840
120 mg1l
7 gpm
7.21 @ 23.1 C
Characteristics (Scale= 1-10)
Color Odor Turbidity Floating Solids Suspended Solids
91
1
0
88
0
1
43
2
1
97
0
2
44
1
0
11
0
1
#6
0
1
31
0
1
Foam Oil Sheen Erosion/Deoosition
#1
1
0
0
#3
0
0
0
#4
1
1
0
#6
0
0
0
We are pleased to provide you data for this storm water event. Should you
need further assistance please contact us.
Sincerely,
fi
Randall Jarrell, Environmental Biologist

rat.
CSNI- �Gj)
www.encolabs.com
ANALYTICAL RESULTS
Description: Stormwater * 6 Lab Sample 1D:CA0848n-01 Received: 05/30/17 12:30
Matrix: Water Sampled:05/24/17 15:40 Work Order: CA08480
Project: Moncure Plywood - Sampled By: RANDALL JARRELL
Classical Chemistry Parameters
^ - FNL71 Cary cerbfred a-tyte (NC 5911
Analyter Results Etn VAM DF MOL MLL Batch Method Analyzed —By Notes
Chemical Oxygen Demand^ 120 mg/L 1 10 10 7F02008 SM 5220D-1997 06/02/17 17:37 ]0C
Description: Stormwater # 4 Lab Sample ID:CA08480-02 Received: 05130/17 12:30
Matrix: Water Sampled:05/24/17 15:50 Work Order: CA08480
Project: Moncure Plywood - Sampled By: RANDALL JARRELL
Classical Chemistry Parameters
^ - EACIP Cary cert flee arrafyte INC 591J
Analyte rCAS Numbed Results Flaa ni DF MDI PQL Batch Method Analyzed IY Notes
Chemical Oxygen Demand^ 39 mg/L 1 10 10 7F02008 SM 5220D-1997 06/02/17 17:37 30C
Description: Stormwater # 3 Lab Sample ID-CA08480-03 Received: 05/30/17 12:30
Matrix: Water Sampled:05/24/17 16:00 Work Order: CA08480
Project: Moncure Plywood - Sampled By: RANDALL JARRELL
Classical Chemistry Parameters
^ - fNCO Cary ceftflied anafyte INC 5911
Analyte [CAS Numberl Results an Units DE MOL P-QL aatch Method Analyzed Dy Notes
Chemical Oxygen Demand^ 1100 mg/L 4 40 40 7FO2008 SM 5220D-1997 06/02/17 17:37 i0C
Description: Stormwater # 1 Lab Sample ID:CA08480-04 Received: 05/30/17 12:30
Matrix: Water Sampled:OS/24/17 16:20 Work Order: CA08480
Project: Moncure Plywood - Sampled By: RANDALL JARRELL
Classical Chemistry Parameters
^ - ENCO Cary rertiried afraly to INC 5911
AnaMe rCAS Numberl Results flag Units DF MDL POL Batch Method Analyzed am Notes
Chemical Oxygen Demand^ 310 mg/L 2 20 20 7F02008 SM 5220D-1997 06/02/17 17:37 30C
FINAL This report relates only to the sample as received by the laboratory, and may only be reproduced in full. Page 4 of 8

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑[
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site mdth the facility SPPP. RECEIVED
Facility Name: _Moncure Plywood JUN 0 6 Z017
County: Chatham y CENTRAL FILES
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4 DWR SECTION
Outfall No. _1�
Is this outfali currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 fast year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SW U-264-Generic-13 Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 4
Outfall No. —3_
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ® No ❑
Yes® No El
Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/1)
TSS (mgll)
Date Sample
Collected 1t��y�*�i
mm/dd/yy
4�y
� R� � �: 19
�� *'a.� ,
� � '`,�
� Wiz•°: _
_ .-,LK h� y ��, �
� :� �
�h :`�r�� dw
,� . �n �
'Z%� 41i eh .u�Ri; �•'
�� x ;
x'3' �g[�"�' ! _rr �tl
� � �
` `� �i �`
Ts � 3
� f �i�`
�$j!4?� 1 f���wa y
i-' ` i �. fd �'.'t
7F '
'"T
04/24/17
2.14
610
SW U-264-Generic-13 Dec2012

Additional Outfall Attachment
Outfall No. _4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑ ,
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD (mg/lJ
TSS (mgly
O & G (mg/l)
Date Sample
Collected,
mmlddlyy
04124/17
2.14
SWU-264-Generic-130ec2012

Additional outfall Attachment
Outfall No. 6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD (mg11)
TSS (mg11)
O & G (mg/1)
Date Sample
Collected,
mmlddlyy
MMMMMMMMM
04/24117
2.14
67
SW U-264-Generic-13 Dec2Q 12

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 tines nd imprisonment for knowing violations."
Signature �
a��U�
Date 5/361rZc € :�-
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa. NC 28778
[phone]
RALEIGH REGIONAL OF_F
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGI _ORAL O_FFIC_ E
585 Waughtown Street
Winston-Salem, NC 27107
336) 771-5000
FA.YETTEVILL.E_REGIONA_L OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFIC_ E
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
'ILMINGTON RECIONA_L OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To preserve, protect
and enhance
North Carolina's %vater... "
SWII-264-Generic-13Dec2012

• STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 4
Outfall No. _1_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑ ;
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
i Parameter, (units) l
Total
Rainfall,
inches
`
Benchmark
N/A
COD (mg/1)
TSS (mg/l)
n
Date
at
Coiiected
dl
mmld yy
'' '
ti •,.Yh �
�`� : <
, �.��
k 6 r.-I.
"�. �'' - ya '.•- h
_�
�
-
i ..
� ���.:4 .. '�'
x r
� �.a , �
q a
- 4 F5 -t':t p :
'! _.7 ti�
I _
� ,;�a � .fir 3. i �
..
— , — G
�.y ay'^F�aA
` � 5 -� ,.r�� Sj i".,,
c�...�,�., � � ,
f.
"a - .-�; a-';
y
il. - � '<�. k'4
�' � o � �"' , �
r n
_. er ..n
y x, � w�.�'.�9 .Y _
�,.�•<r �
r
.—
l• r 4 "ye'yr � 'den �'i' ti-
�` � err �: � ,
,�•.: .7
:3
h� .�
, t
04/24/17
2.14
300
I
i
I
SWU-264-Generic-13Dec2012

(1) Boise Cascade
Moncure Plywood Plant
CERTIFIED MAIL/RETURN RECEIPT REQUEST
7016 2710 0000 7769 7688
May 30, 2017
Attention: Central Hiles
NC Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Moncure Plywood
NPI)ES Permit: NCO023442
Moncure, Chatham County, NC
:06 Col im11 Rd
Moncure, NC 27559
(919)-542-231i
PAX (919)-542-6646
This. letter is sent in regard to the storm water DMR for April 2017 in accordance with NPDES permit NC0023442. if
additional in Formation is required, please contact me at [phone].
Sincerely,
iL, V
Brian Van Gelder
Moncure Plywood
[phone]

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000 jU C G 0 / p o 33
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood_
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored _4
Outfall No. T1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
RECEIVED
MAY 0 5 2017
CENTRAL FILES
DWR SECTION
Parameter, (units)
Tota
Rainfall,
inches
Benchmark
N/AI
COD (mg/I)
TSS (mg/I)
Date Sample
Collected,
mmlddlyy
E========
03/14/17
.98
460
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood,
County: _Chatham
Phone Number: (_803_)_385-4957
Outfall No. 3
Total no. of SDOs monitored 4
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ® No ❑
Yes ® No ❑
Yes El No®
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/!j
TSS
Date Sample
Collected,=
mmlddlyy
=
=
=
03114/17
.98
630
SWU-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. ^4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
coD (mg/1}
TSS (mg/1)
O & G (mg/IJ
Date Sample
Collected,
mmlddlyy
MMMMMMMMM
03114/17
.98
77
SW U-264-Generic-13 Dec2012

Additional Outfall Attachment
Outfall No. T6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD (mg/1)
TSS (mg/1)
O & G (mg/1)
Date Sample
Collected,Elm
mmlddlyy
M
M
M
M
M
M
M
03/14/17
.98
67
SWU-264-Generic-1 Mec2012

I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
Signature
Date ¢�Z�1�
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
i
R_ A_LEIG_H_REGIO_NAL OFFIC
3800 Barrett Drive
Raleigh, NC 27609
1 [phone]
WIN_ ST_ON-SALEM REGIONAL OI
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON RECIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
40ORESVILLE REGIONAL OFFICI
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
ILMINGTON REGIONAL OFF11
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
70 preserve, protecl
and enhance
!North Carolinas waler..."
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
/VED
APR o g 201?
This monitoring report summary of the calendar year should be kept on file on -site wR*,�.t'fPPP.
SEC rj0N
Facility Name: _Moncure Plywood.
County.- _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored _5
Outfall No. J1�
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg11)
TSS (mg11)
Date Sample
mmlddlyy
3:
02/15/17
.58
240
56
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood.
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 5
Outfall No. �3_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Tota I
Rainfall,
inches
Benchmark
N/A
COD (mg/!)
TSS (mg11)
Date Sample
Collected,
mmlddlyy
-
02115117
.58
490
82
SW U-264-Generic-13 Dec2012

Additional Outfall Attachment
Outfall No. _4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD (mg/1)
TSS (mg/1)
O & G (mg/1)
Date Sample
Collected,
mmlddlyy
02/15117
.58
45
19
<2.4
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood_
County: _Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored —5
Outfall No. J5
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
NIA
COD (mg11)
TSS (mg1l)
Date Sample
Collected,
mmlddlyy`t
r�
-
02115/17
.58
110
34
SW U-264-Generic-13 Dec2012

Additional Outfali Attachment
Outfall No. _6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
I COD (mg/1)
TSS (mg11)
O & G (mg/1)
Date Sample
Collected,
mmlddlyy
MMMMMMMMM
02/15/17
.58
92
51
SW U-264-Generic-13 Dec2012

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 possibil of fines, nd imprisonment for knowing violations."
Signature
Date 1+
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive -.--
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFFICE_
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
F_A_Y_E_ TTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE_
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
ILMINGTON REGIONAL OFFU
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To preserve, protect
and enhance
North Cantina's svater._."
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017 RECEIVED
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or 17
Certificate of Coverage (COC) No. NCG210000 �CENTRAL FILES
}
/Gb 3� DWR SECTION
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood
County.- _Chatham
Phone Number: (_803_)_385-4957 Total no. of SDOs monitored 4
Outfall No. �1r
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/!)
TSS (mg/!)
Date Sample
Collected,
mmlddlyy
01/31/17
No Flow
SWU-264-Generic-13Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG210000
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: _Moncure Plywood.
County: Chatham
Phone Number: (_803_)_385-4957
Total no. of SDOs monitored 4
Outfall No. �3_ _
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
I COD (mg1l)
TSS (mgll)
Date Sample
Collected,
mmlddlyy
E========
01/31/17
No Flow
SWU-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. �4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Parameter, (units)
Total
Rainfall,
inches
Benchmark
N/A
COD (mg/1)
TSS (mg/!)
O & G (mg11)
Date Sample
Collected,
mm/dd/yy
01/31/17
No Flow
SW U-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. �6
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
:Parameter;{units)v.�``
Total
Rainfall,
inches
p
S
Benchmark
N/A
COD (mg/!j
TSS (mg/!)
O & G (mgly
Date.Sample
Collected,
mmlddlyy
MMMMMMMMM
01/31/17
No Flow
SWU-264-Generic-13Dec2012

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 anl belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the poss)bilit& fines and imprisonment for knowing violations."
Signatu
Date
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
2090 US High Aay 70
Swannanoa, NC 28778
[phone]
RA_LEIGH REGIONAL OFFIC
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL Ol
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
AVETTEVILLE_REGIONAL _OFF
I
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
943 Washington Square Mall
Washington, NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
'To preserve, protect
and enhance
North Carolina's water... "
S W U-264-Generic-13 Dec2 012

Baxter
January 26, 2017
NCDENR Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
G ggst)
GEN��EG� ON
p�R
RE: Certificate of Coverage No. NCG210028 f
Year 4 — Period 1
Stormwater Discharge Outfall MonitoringReport [jrv;
P
Baxter Healthcare Corporation OP
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Permit, Part
1I, Section B. We will continue to monitor the outfalls as required.
If you have any questions regarding this application, please contact Mike Pisarik at 828-756-6017 or
michael i sari kbaxter.corn .
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 the 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.
Sincerely,
J6n Rushford
VP Operations- North Cove
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
Baxter Healthcare Corporation
PO Box 1390, Marion, NC 28752
i' 828.756,4151

Semi-annual Stormwater Discharze Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submittedy
CERTIFICATE OF COVERA E NO. NC 21Q o a g
FACILITY NAME o-e(- CJaa D 11-1
COUNTY
PERSON COLLECTING SAMPLES oti "115
LABORATORY 9, �Hf"e Lab Cert. # AX, CY)
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR '�-O 14
SAMPLE PERIOD ❑Jan -June CJuly-Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [-]SA
✓ ECE VEjo ❑Other
F'E& 0 ZOl7 PLEASE REMEMBER TO SIGN ON THE REVERSE
f.
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is ' it-ba,o Iy.j f facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.) �ECTlQN
No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches-3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =__>
_
-
120 mg/L
100 mg/L or 50 mg/0
o&�y
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
° See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they mu t be reported in the format "<XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
(Vote: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/0
Footnotes from Part A also apply to this Part B
Note: if you report a sample value in excess of the benchmark, you must Implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cogv of this DMR. includina all "No Discharae" resorts. within 30 days of receipt of the lab results for at end of monitorina period
in the case of "No Discharae" reports] 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 sigpiicant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
Permit Date: 8/1/2013-7/31/2018
�/ 2, 1 /
(Date)
SWU-245, last revised 7/31/2013
Page 2 of 2

��
C�,V -A
r
f �■ ftle
�I
� I�CDENR
Stormwater Discharge Outfall (SDO) o�Nr PEa 0,9 �a»
Qualitative Monitoring Report 41� 14(,cl
SFCT,o�s
For guidance on filling out this form, please visit:
11
11
Permit No.: �V/�/_/ /_//_/�/w/ or Certificate of Coverage No.: NI/C1Q1—/—/—/—/—/—/
Facility Name: �rz• ;t.�1.1L«�
County: D c 6kjU� „ Phone No.
Inspector: _w\ . 14 5
Date of Inspection: � L 1 [a
Time of Inspection: 1 <10
Total Event Precipitation (inches): -1 � --
Was this a "Representative Storm Event" or eattirea le rm Event as defined by the permit?
See inf )
mation below. �.
,
D
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.
`s
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 thi�.sfgnature, I certify that th1s�rrt is accurate and complete to the best of my knowledge:
of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

in
1. Outfall Description: ~
Outfall No. Structure (pipe, ditch, etc.) fp
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: Lo co�r r Z lab �
U'
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L" f g ro .✓�
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): ALA,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 4 5
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: '
f 1) 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, ere 1 is no solids and 5 is extremely muddy:
1 2 3 4 5
7. Is there any foam in the stormwater discharge?i Yes qNo8. Is there an oil sheen in the stormwater discharge? Yes
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
5WU-242, Last modified 10/25/2012

Month t Date
Scale Calib tion:
70 SHEDAILYETS
Day 2 T W T� Analyst
Refrigerator Temp.= q °C
10.0 g= 20. g=
Suspended Solids Analyst ") k-� Checked By IlQuarteriv TSS Standard
uJ S A. Basin #1 A. Basin #2
Std. Meth 22nd Ed. 2540 D) E+fhief:14— M.L.S.S. M.L.S.S. Eff. Dt
Crucible 1
Volume (ml-) fie,
Second Wt. (mg) 2g, 2,
First Wt. (mg) 11 a,
Difference (mg) `.ffo
Factor
Sus. Solids (mg/L)
Average mg/L (if Effluent and Effluent Duplicate run)
Oven Time IN= Oven Temperature= 10,
Oven Time OUT= 1 1 3 Relative % Diff. _
*note: reporting limit for T55 is 2.5 mgll*
na vst Checked Bv
00 C�-
g Year '20 [6,
Daily 1.0 g= I - "'0 \ Quarterly 20 mg=
Method 8000)
Sample COD
High Range
Blank
CVS-750 mg/L
EQ Basin
Influent
©
—i
Blank
Reactor Temp.=(b� °C
Time Heat On=0_
Time Heat Off=— 3 0
Average results if duplicates are run
I
Post run Blank YES
Post run CVS-750 mg/L QC METr
Leceptable high range CVS is 675 to 825 mg/L RPD (Duplicates oniy)
kcceptance Criteria for Post runs is: < plus or minus 5o mg/L
-------------------------------------------------------------------
Low Range Sample mL COD mg/I
Blank 2 0
CVS-70 mg/L 2
Effluent 2 AveragE
�J S ") 2 �
2
Post run Blank 2
Post run CVS-70 mg/L 2
ceptable low range CVS is 63 to 77 mg/L
MW
Checked By 0
40.0 g= % -
T Analyst
Crucible
Volume (mL)
NSI Low Level TSS Slid
Second Wt. (mg)
OCI-057
First Wt. (mg)
Lot #
Difference (mg)
Exp. Date
Factor
Sus. Solids (mg/L)
ACCEPTANCE
LIMITS mg/I
Oven Time IN=
I
I CERT CONC. Mg/I
Oven Time OUT=j
Results Acceptable?
Oven Temperature
m
Analyst S
Checked By
Collection Time
Influent
Effluent
C'Sii t6 �-
5
-----------------------------------
pH
Calibratior
results if duplicates are run.
Time
YES
QCMET f
RPD (Duplicates only)
NO jAnalyst
Temperature Preserve Tim
Influent °C
Effluent °C
Time Received in Labl 9/5r,y
4.0 Standard 7.0 Standard 10.0 Standard %meter slope 7.0 Check
nus 2.5

July 21, 2016
NCDENR Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 3 — Period 2
Stonmwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
RECENED
�a 6 Z016
pWRSAL FILES
ECTION
Baxter
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Permit, Part
II, Section B. During the rain event on 2/3/16, the discharge sample exceeded the benchmark value for
COD and TSS. In response, we conducted a stonnwater management inspection on 5 February and
implemented corrective actions in accordance with Part 1I, Section B Tier One requirements. These
corrective actions included installation of a filter media bag on the stormwater collection tank overflow
pipe. Initial testing reduced the TSS and COD to within acceptable levels. We are confident that these
corrections will reduce solids and subsequent COD Ievels in our discharges to below benchmark
concentrations.
If you have any questions regarding this application, please contact Mike Pisarik at 828-756-6017 or
michael pisarik a,baxter.com .
1 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 the persons directly responsible for gathering the information, the information submitted is, to
the best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant
penalties for submitting false information including the possibility of fines and imprisonment for
knowing violations.
Sincerely,
Peter
Plant
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
Baxter HeWthcare Corporation
h0 Box 1390, Marion, NC 28752
l' 828.756.4151

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG21 Q SAMPLE COLLECTION YEAR '�_() 1 (�
I A�
FACILITY NAME ocrk �� ji f AMPLE PERIOD Jan -June ❑July -Dec
COUNTY Pc.�b w ( KR ECE V ED or ❑ Monthly' (month)
PERSON COLLECTING SAMPLESt .� 201OISCHARGING TO CLASS [jORW ❑HQW ®Trout ❑PNA
LABORATORY r l Lab Cert. # �� 0 � `1 3 s JUL �' 6 [_]zero -flow ❑Water Supply ❑SA
Comments on sample collection or analysis: CENTRAL FILES ❑Other
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period:2
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches;
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks ===>
-
-
120 mg/L
100 mg/L or 50 mg/L°
Q c ; ew,
B 3 i !o
1)
i
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
" See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L". where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 5WU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L°
1114
Nib
N�
N
A)
Footnotes from Part A also apply to this Part B
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copv of this DMR. includina all "No Discharge" retorts, within 30 dovs of receipt of the lab results (or at 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, 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 thatnu lified personnel properly gather and evaluate the information submitted._ Based on my inquiry of the person or persons who manage the system, or
those pers ns irectly responsible for gathering the information, the information submitted is; to the best of my knowledge and belief, true, accurate, and complete.
am awareP4 thete are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
4
(S
20 1 G
(Date)
Permitte: 8/ 013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

�r I
ffl;A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: p;f /portal.ncdenr.org/web/lr/npdes-stormwater/
Permit No.: N/C/A;:/2-/J//ti/ U/ C� or Certificate of Coverage No.: N/C/G/� f1/�/�/ Z/�/
Facility Name: 3AKIr-1 W du d v. kK
County: -v4f // hone No. 412g - 7S6 - 1,012
Inspector: _Erif Wut��Q_
Date of Inspection:
Time of inspection:
Total Event Precipitation (inches): JUL 2 6 2016
CENTF1l.
Was this a 'Representative Storm Event" or "Measureable Storm Event" as de R&lr it?
(See information below.)
AYes ❑ 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.
f 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, l�eVify that this report is accurate and complete to the best of my knowledge--
(Signature of �ermitteeor Designee)
11 \\ `` ,
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description: D
Outfall No. Structure (pipe, ditch, etc.) -Ape
pe
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: 1r,-5�i� lrJ/I
2. Color: Describe the color of the discharge using bra
colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:. M rAs;et.1 rajLr_n
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): �f
I ,
4. ,,Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
!1J 2 3 4 5
7. Is there any foam in the �-/
stormwater 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 CN
10. Other Obvious Indicators of Stormwater Pollution:
,vf List and describe I -
C
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. 40
Page 2 of 2
SWU-242, Last modified 10/25/2012

W0-0 �--7)4L� �
Month Date Year
Scale Calibration:
DAiLYSHEET
Day M T W Analyst Checked By
Refrigerator Temp.= °C
11
uall 1 .0 = uuarteriy 2U m = 1 U.0 q=
n.0 g=
4U.0 g=
Suspended Solids Analyst_ Checked By
Quarterly TSS Standard
Analyst .
A. Basin #2
(Std. Meth 22nd Ed. 2540 D) f#fltrerrt- M.L.S.S. M.L.S.S. Eff. Dup. Blank
Crucible
Crucible 4�w
Volume (mL)
NSI Low Level TSS Std
Volume (mL) 30
Second Wt. (mg)
OCI-057
Second Wt. (mg) 13 �.
First Wt. (mg)
Lot #
First Wt. (mg)
Difference (mg)
Exp. Date
Difference (mg) I q,rp
Factor
Factor 33,3
Sus. Solids (mg/L}
Sus. Solids (mg/L)
ACCEPTANCE LIMITS mg/I
Average mglL (if Effluent and Effluent Duplicate run)
Oven Time IN= CERT CONC. Mg/I
Oven Time IN= ��3a Oven Temperature= °C
Oven Time OUT=
Results Acceptable?
Oven Time OUT= Relative % Diff. _ %
Oven Temperature=
°C
note: reportinq limit for TSS is 2.5 mg/l*
Method 8000)
High Range
Blank
CVS-750 mg/L
EO Basin
Influenl
5�
/Analyst
Sample COD
y
Reactor Temp.= 4 S, °C
Time Heat On= ` 216
Time Heat Off= L?,?�
Average results if duplicates are run
Post run Blank YES
Post run CVS-750 mg/L OC METI
Acceptable high range CVS is 675 to 825 mg1L RPD (Duplicates only)
NO
Acceptance Criteria for Post runs is: c pi us or minus 50 mglt-
------- - -------------------------------------------------------------------------------
Low Range Sample mL COD mg/I
Blank
CVS-70 mg/L
E�f�,+�nt
,4 w
Post run Blank
Post run CVS-70 mg/L
ceptable low range CVS is 63 to 77 mg1L
©ram'
e sampies
Analyst
Checked By
Collection Time
Influent
Effluent
p�o
Temperature
Influent °C
Effluent °C
Preserve Tim
Time Received in Lab
Calibration 4.0 Standard 7.0 Standard 10.0 Standard %meter
Average results if duplicates are run.
Time
YES NO
QC MET
RPD (Duplicates only) I %
7.0 Check
inus 2.5 m
e sampies
Analyst
Checked By
Collection Time
Influent
Effluent
p�o
Temperature
Influent °C
Effluent °C
Preserve Tim
Time Received in Lab
Calibration 4.0 Standard 7.0 Standard 10.0 Standard %meter
Average results if duplicates are run.
Time
YES NO
QC MET
RPD (Duplicates only) I %
7.0 Check
inus 2.5 m

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted D
Ti
CERTIFICATE OF COVERAGE NO. NCG21 0 B
FACILITY NAME _I'pr
COUNTY %f .
PERSON COLLECTING S MPLES1'
LABORATORY Lab Cert. # ZJL60
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR �, D / 9
SAMPLE PERIOD LZ'Jan-june July -Dec
or Lj ❑ Monthly' (month)
RECEDISHARGING TO CLASS ❑ORW ❑HQW Trout ❑PNA
� ❑Zero -flow ❑Water Supply ❑SA
AUG 2 6 1014 ❑Other
CENTRAL FIEFS PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
0No discharge this period?z
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =__>
_
-
120 mg/L
100 mg/L or 50 mg/L
NA-
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L", where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 5WU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L
>�Al
N
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. see General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one coov of this DMR, including all "No Discharae" reports, within 30 dovs of receipt of the lab results (or at end of monitorina period
in the case of "No Discharae" reports) 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."
(Signature
aT'2 z�`
(Date)
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

Baxter
22 August 2014
NCDENR Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 1 — Period 2
Stonnwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
Enclosed is the stormwater discharge outfall monitoring report as required by the General Stormwater
Permit Part 11, Section B. There were no measurable storm events during this reporting period as
defined by the General Permit Part 11, Section B.
Baxter Healthcare is submitting this application after the 30 day deadline due to the illness and absence
of our primary Environmental Engineer and turnover of key personnel. We sincerely apologize for any
inconvenience and have put measures in place to avoid a similar situation in the future.
If you have any questions regarding this application, please contact Mike Pisarik at (W) 828-756-6017 '
or michaelyisarik a,baxter.com .
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 the 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.
Sincerely,
C ,. U.,
��-
Alan Weiler
Plant Manager
Enclosures: Semiannual DMR
Cc: Rick Styles
Baxter Healthcare Corporation
PO Box 1390. Marion, NC 28752
T 828.756.4151

Semi-annual Stormwater Discharge Monitoriniz Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG21 6 0 `L S'
FACILITY NAME 8 ,x-fr (J"� j3,�r'I�
COUNTY L�L _ rat=) v, /l _
PERSON COLLECTING SAMPLjS1 i1tir� l" v1
LABORATORY A&,)._kr #"_ . [ a_r-t_ Lab Cert. it A) C 00 q 3 S
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR `� f7 I Y
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly' month
DISCHARGING TO CLASS ❑ORW ❑HQW KTrout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks ==_>
_
-
120 mg/L
100 mg/L or 50 mg/0
4�o�
�� r
�.8'
l 3
L
— 01
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be -recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
° See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format. "<XX m L" where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
El No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/0
Af
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one coov of this DMR, including all "No Discharge" reports. within 30 days of receipt of the lab results (or at end of monitorina period
in the case of "No Dischorae" reports) 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."
of Permittee)
Permit Date:8/1/2013-7/31/2018
(D te)
SWU-245, last revised 7/31/2013
Page 2 of 2

Barer
January 9, 2015
NCDENR Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 2 — Period 1
Stormwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Permit, Part
I1, Section B. During the rain event on 7/18/14, the discharge sample exceeded the benchmark value for
COD. In response, we conducted a stormwater management inspection with the help of a third party
engineer firm, identified possible causes, and implemented corrective actions in accordance with Part II,
Section B Tier One requirements. These corrective actions include maintaining a lower water level in
the collection pit to reduce the chances of a measurable event, improved equipment cleaning BMPs to
reduce solids entering the collection pit, and maintaining a greater standoff distance between storage
piles and vegetated buffers along the drainage ditch. We are confident that these corrections will reduce
solids and subsequent COD levels in our discharges as well as reduce the number of actual discharges.
If you have any questions regarding this application, please contact Mike Pisarik at (W) 828-756-6017
or michael pisarik cr,baxter.com .
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 the persons directly responsible for gathering the information, the information submitted is, to
the best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant
penalties for submitting false information including the possibility of fines and imprisonment for
knowing violations.
Sincerely,
lan Weiler
Plant Manager
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
Baxter Healthcare Corporation
PO Box 1390, Marion, NC 28752
T 828.756.4151

L
0
C]
CCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform, please visit: -
Permit No.: LV/�
Facility Name:
County:
Inspector: E
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): 11
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, t
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 out€all. The previous measurable storm event must have been at least 72 hours
j 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:
of Permittee or Designee)
Page 1 of 2
5WU-242, Last modified 10/25/2012

r
1. Outfall Description: f�
Outfall No. f o .,le)Structure (pipe, ditch, etc.) / �P
Receiving Stream: A/ta
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the dis harge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Z41,2 aJ L.i s�' _
3. Odor: Describe any distinct odors that the discharge may have (i.e, smells strongly of oil,
weak chlorine odor, etc.): )ODAI-o
4. Clarity: Choose the number which best describes'the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 Q;) 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:
Q2 3 4 5
b. Suspended Solids: Choose the number which hest describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 Q 3 4 5
7. Is there any foam in the stormwater 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
SWU-242, Last modified 10/25/2012

DAILY LABSHEET
Month > v( Date 2 t Year 2-D {'{ Day & W T F Analyst �'j
Scale Calibration: Refrigerator Temp.= 3 °C
Dail 1.0 = / • 42 odl Quarterly 20 m = 10.0 g= 20.0 g=
Checked By
40.0 g=
Suspended Solids Analyst _S� Checked By
Quarterly TSS Standard
Analyst
&y -cr A. Basin #1 A. Basin #2
Uft7eTlt
(Sid. Meth 22nd Ed. 2540 D) M.L.S.S. M.L.S.S. Eff. Dup. Blank
Crucible
Crucible Lf
Volume (mL)
NSI Low Level TSS Std
Volume (mL) 3 &C)
Second Wt. (mg)
OCI-057
Second Wt. (mg) 129.1 ,(�
First Wt. (mg)
Lot #
First Wt. (mg) 11g, I. //$':(f
Difference (mg)
Exp. Date
Difference (mg) 1 0. 0
Factor
Factor, 3.3 3
Sus. Solids (mg/L)
Sus. Solids (mg1L)3 .g 1
ACCEPTANCE LIMITS mg/I
Average mg1L (if Effluent and Effluent Duplicate run)
Oven Time IN= CERT CONC. Mg/I
Oven Time IN= r 0 D2— Oven Temperature= f bet °C
Oven Time OUT=
Results Acceptable?
Oven Time OUT= I1.fo Relative % Diff. _ %
Oven Temperature=
°C
note: reporting limit for TSS is 2.5 mg/l*
HACH Method 8000)
High Range
Blank
CVS-750 mg/L
EQ Basin
Influeni
U3 SW —
-
Analyst_ sg-
Sample COD
Q-�
Reactor Temp.= 1 S ! °C
Time Heat On=
Time Heat Off=
wall f
RMF'h f results if duplicates are run
Post run Blank YES NO
Post run CVS-750 mg/L QC MET
,cceptabie high range CVS is 675 to 625 mg/L RPD (Duplicates only
,cceptance Criteria for Post runs is: < plus or minus 50 mg
Low Range Sample mL COD mgll
Blank
CVS-70 mg/L
w a wen
Post run Blank
Post run CVS-70 mg/L
ceptable low range CVS is 63 to 77 mg/L
ceotance Criteria for Post runs is: < olus
©
Q_
or minus 2.5
Average results if duplicates are run.
YES NO
QC MET
R P D (Duplicates only) I %
Analyst
Checked By
wo-OS
Collection Time Temperature
Effluent Effluent °C
I:
?/ 9�ev
Preserve Time
Time Received in Lab
bration 4.0 Standard 7.0 Standard 10.0 Standard %meter
Time
7.0 Check
Benchot revised on 6/12/2013 0 0

E

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMER General Permit No. NCG210000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG21 Q 2 �
FACILITYNAME Pax4r- E.J6#) Bnr �
COUNTY #
PERSON COLLECTING SAMPL Uri Aluin
LABORATORYake Go rt _ Lab Cert. 11 00g 3 s �!
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR `X— () l
SAMPLE PERIOD ❑Jan -June July -Dec
or ❑'Monthlyl month
DISCHARGING TO CLASS ❑ORW ❑HQW Trout ❑PNA
❑Zero -flow [:]Watersupply [:]SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period?Z
Outfall Nb �.
•v -, ] }�
;Date Sample At
,:
f'" Coilectedl t
(mo/dd/yr)?_
,%!, .r s ��d
24-hour rainfall
amount,
{ .Inches3.
� . 'p �I :.
�_; , °� c�
Chemical 0irygen Demand
r Y, s -. ;-. cif t,•
. wt- :�� r Imo?
Total Suspended Solids `
r
'Be'nchmarks'==-3�,�
.,�� ` ',' '
Ja
i 120 mg/L ' :i
-100 mg/L or 50 mg/
07 l g 1
/.t
143 L
L
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfali, you must -still submit this discharge -monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
° See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not reportBelow Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format "<XX m L" where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit team.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period?x
Date Sample
24=hour rainfall
0utfall Na. .
Collected; TF
amount,
Non=polar O&G by EPA
TotaLSuspended Solids
-
(mo/dd/yr)• •:
' IncheO
== 1664 (SGT-HEM):
Benchmarks.===> .
_
-
15
10Omg/Lar56,mg/L ,; ,
Amg/L.
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
+ A 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copv of this DMR, includina all "No Discharae" reports, within 30 dovs of receipt of the lab results !or at end of monitorina period
in the case of "No Discharae" reports! 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee)
At 1, 5-
(D te)
Permit Date; 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

January 9, 2015
NCDENR Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 2 —Period l
Stormwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
Baxter
CAN
DwR ECrjoN
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Permit, Part
II, Section B. During the rain event on 7/18/14, the discharge sample exceeded the benchmark value for
COD. In response, we conducted a stormwater management inspection with the help of a third party
engineer firm, identified possible causes, and implemented corrective actions in accordance with Part I1,
Section B Tier One requirements. These corrective actions include maintaining a lower water level in
the collection pit to reduce the chances of a measurable event, improved equipment cleaning BMPs to
reduce solids entering the collection pit, and maintaining a greater standoff distance between storage
piles and vegetated buffers along the drainage ditch. We are confident that these corrections will reduce
solids and subsequent COD levels in our discharges as well as reduce the number of actual discharges.
If you have any questions regarding this application, please contact Mike Pisarik at (W) 828-756-6017
or michael pisari k[r baxter.com .
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 the 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.
Sincerely,
a, 4V)
]an Weiler
Plant Manager
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
REC�lVED
JAN 2 9 Z015
CENTRAL FILES
DWR SECTION
Baxter Healthcare Corporation
PO Box 1390, Marion, NC 28752
T 828.756.4151

DAILY LABSHEET
Month v_l Date2.(._Year4--2-0-(-'{-- Day %T-W T F Analyst Checked By
Scale Calibration: Refrigerator Temp.= 3 °C
Daily 1.0 a= t • S AN Quarterlv 20 mq= 10.0 q= 20.0 q= 40.0 q=
Suspended_ Solids Analyst_ 1- Checked By
Quarterly TSS Standard
Analyst
sw
W � A. Basin #1 A. Basin #2
kt
(Std. Meth 22nd Ed. 2540 D) UM.L.S.S. M.L.S.S. Eff. Dup. Blank
k;un
Crucible
Crucible
I iVolume
(mL)
NSI Low Level TSS Std
Volume (mL)
3&u
Second Wt. (mg)
OCI-057
Second Wt. (mg)
12 K. I
IM&
First Wt. (mg)
Lot #
First Wt. (mg)
11S.1
11$' G
Difference (mg)
Exp. Date
Difference (mg)
I o. p
Factor
Factor
3.33
Sus. Solids (mg/L)
Sus. Solids (mg/L)
',3 _.3
ACCEPTANCE
LIMITS mg/1
Average mg/L (if Effluent and Effluent Duplicate run)
Oven Time IN=
CERT CONC. Mg/1
Oven Time IN=
i o o� Oven Temperature=9-C
Oven Time OUT=
Results Acceptable?
Oven Time OUT=
1 v Relative % Diff. _
%
Oven Temperature=
°C
note: reoortino limit for TSS is 2.5 moll*
U
Analyst S Q—
H Method soon)
Sample
COD
High Range
r®
Reactor Temp.= 1 S ► °C
Time Heat On=
Time Heat Off=
7W 1,16f
Wrty� results if duplicates are run.
Post run Blank YES NO
Post run CVS-750 mg/L QC MET
Lcceptable high range CVS is 675 to 825 mg/L' RP❑ (Duplicates only)
keeeptance Criteria for Post runs is: < plus or minus 50 mg
----------------------------------------------------------- ----------------------------------------
Low Range Sample mL COD mg/1
Blank
CVS-70 mg/L
w a w en
sr- 7/z)I (If
Post run Blank
Post run CVS-70 mg/L
:ceptable low range CVS is 63 to 77 mg/L
meptance Criteria for Post runs is: < plus or minus 2.5
Reactor Temp.= 1 S ► °C
Time Heat On=
Time Heat Off=
7W 1,16f
Wrty� results if duplicates are run.
Post run Blank YES NO
Post run CVS-750 mg/L QC MET
Lcceptable high range CVS is 675 to 825 mg/L' RP❑ (Duplicates only)
keeeptance Criteria for Post runs is: < plus or minus 50 mg
----------------------------------------------------------- ----------------------------------------
Low Range Sample mL COD mg/1
Blank
CVS-70 mg/L
w a w en
sr- 7/z)I (If
Post run Blank
Post run CVS-70 mg/L
:ceptable low range CVS is 63 to 77 mg/L
meptance Criteria for Post runs is: < plus or minus 2.5
©-I
©Q'
Average results if duplicates are run.
YES NO
QC MET
RPD (Duplicates only)
Analyst_
Checked By
W0®� 3,'tSi.- f, W s rjyft.— Ile,kc(
1/S A7W►
Collection Time Tem erature
-+n#la.em / f / ar 3 °C
a` Effluentj Effluent °C
Preserve Time
Time Received in Lab
ibration 4.0 Standard 7.0 Standard 10.0 Standard %meter
Time
alyst
7.0 Check
' „ Benclit,_.et revised on 611212013

KtiK
10)
I I.

L.J
XNR
Storin'water Discharge .Outfall. [SD'U)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit:
Permit No.:
Facility Name: AhCOA
County: ur
Inspector: � -. A4
Date of Inspection:
Time of Inspection:
or Certificate of Coverage No.:
�r
Total Event Precipitation (inches): I.
Phone No.
I
iffftsr
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes F-1 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
tperformed 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.
i
i 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
Lobtains approval from the local DWQ Regional Office.
By this signat-qre, I certify that this report is accurate and complete to the best of my knowledge:
re of Permittee or Designee)
Pagel of 2
,. SWU-242, Last modified 10/25/2012

. J
1. Outfall Description: f�
Outfall No. Q�Ic)AStructure [pipe, ditch; etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage,area:
2. Color: Describe the color of the dis harge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: 0?4. �
3. Odor: Describe any distinct odors that the discha_ rge may have'(i.e.-, smells strongly of oil,
weak chlorine odor, etc.): /�i`O Air)
4. Clarity: Choose the number which best describes;the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 Q�) 3 4 S
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:
Q2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
3
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 Q 3 4 5
7. Is there any foam in the stormwater discharge?,, Yes IVo
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
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
SWU-242, Last modified 10/25/2012