NCG210155_MONITORING INFO_20151110

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV L& J)bl5G
DOC TYPE
❑HISTORICAL FILE
�MONITORING REPORTS
DOC DATE
❑ �po I5
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG2110EIM
FACILITY NAME _ - aRDg1S �tJrr� Or _CI+vA_ S:Upvt
PERSON COLLECTING SAMPLES ..1 CO iTING SAMPLES Cow
CERTIFIED LABORATORY hi ERt keek -LO Lab # ! (c5_—
Lab #
Part A: Specific Monitoring Requirements'
SAMPLES COLLECTED DURING CALENDAR YEAR: 20 f
(This monitoring reports due at the Division no later than 30 days from
th �tj] of V receives the sampling results frorh the laboratory.)
E �/2��5LC000NTY M0r4L(=r-,0r�_
Gov 10 PHONE NO. {a11o) 43��IZ1
DWR� CT oN$LEASE SIGN ON THE REVERSE �
Outfall
No.
Date
Sample Collected,
mo/dd/ r
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
pH,
Standard units
Chemical Oxygen Demand (COD),
Benchmark*
-
100
Within 6.0 - 9.0
120
t
za
3
-20 t
Z
0
*Note: If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit.
'Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
A facility that does not retain exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material on
site for more than seven (7) days before removing the material is not required to monitor for the parameters in Table I of the General Permit. If at any time the material is not removed
within this time frame, the facility must begin analytical monitoring immediately. (Reminder: This condition does not exempt any facilityfrom qualitative monitoring of SDOs.)
If the facility removes such materials within seven days to meet the monitoring exemption, the Permittee shall record and maintain in the facility's SPPP a log which documents, at a
minimum, the dates when material is generated and removed, how removed, and by whom. The log must be sufficient to establish that no materials were exposed for longer than seven
days. For record -keeping purposes, the Permittee may also maintain in the SPPP this form with the signed certification below:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for analytical monitoring, I certify that to the
best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or other similar materials were stored exposed (either to incident precipitation or to
stormwater run on) for longer than seven (7) days before removal since filing the last discharge monitoring report."
l
a &L
Name (Print name)
-I
(Date)
S W U-245-110408
Page I of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
❑ Yes ❑ No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Cotlected,
mo/dd/ r
00400
00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual averse al/mo
pH,
Standard units
Oil and Grease,
Total Suspended Solids,
Benchmark*
-
6.0 — 9.0
30
100
2
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Pernut.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B:
"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 briief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the
possibility of fipcNand iWpr4pnment for knowing violations."
(Signature of 1�0ntittee (Date) —L/— 6
SwU-245-110408
D- 1 -r I

�fu'y�4•
Contact: John Coyle
Client: Jordan Lumber
1939 Hwy 109 S
Mt. Gilead, NC 27306
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Meritech Work order # 10061575 Sample: #1 Grab
Report Date: 10/14/2015
P.O. #: JC100
Date Sample Rcvd: 10/6/2015
10/6/15
Parameters Result a1�i lyyis DaW, ReVorthiglimit Mclhod Qualifier.
Total Suspended Solids 17 mg/L 10/8/15 2.5 mg/L SM 2540 D
Oil & Grease (HEM) 21 mg/L 10/13/15 5 mg/L EPA 1664A
pH 7.5 S,U. 10/8/15 1.0 - 14.0 S.U. SM 4500-1-113 Q1
Meritech Work Order # 10061576 Sample: # 2 Grab 10/6/15
Flarsi-meters Result Analysls Date Re ou rung Limit Method QuJlfiel
COD 207 mg/L 10/8/15 15 mg/L EPA 410.4
Total Suspended Solids 26 mg/L 10/8/15 2.5 mg/L SM 2540 D
pH 6.9 S.U. 10/8/15 1.0 - 14.0 S.U. SM 4500-HB Q1
Meritech Work Order It 10061577 Sample: # 3 Grab 10/6/15
Paranie(Qrss Resull nalysis Date Itenorthtg Lintlt Metliocl Qualiflet
COD 67 mg/L 10/8/15 15 mg/L CPA 410.4
Total Suspended Solids 7 mg/L 10/8/15 2.5 mg/L SM 2540 D
pH 7.1 S.U. 10/8/15 1.0 - 14.0 S.U. SM 4500-1-IB Q1
Meritech Work Order # 10061578 Sample: # 4 Grab 10/6/15
taramgtei Result Analysis Date RepQr ing Limit . Method Qualluel
COD 50 mg/L 10/8/15 15 mg/L EPA 410.4
Total Suspended Solids 43 mg/L 10/12/15 2.5 mg/L SM 2540 D
pH 7.0 S.U. 10/8/15 1.0 -14.0 S.U. SM 45004113 Q1
Q1 Holding time exceeded prior to receipt by the lab.
I hereby certify that I have reviewed aril approve these data.
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Chain of Custody Record (COC)
ff NPDES#:
Client: rD L Phone:
Address: _ 4 a_ C1 _ _ _ Fax:
f� �C�Cj S Email:
alli�-C NZ 2 Project:
Attention:
How would you like your report sent?
Circle all that apply: Email (preferred), Fax, Mall
Ne 2 i 0
GtIiy2�3cj cg%q�
g Zf7 Lf .3
c3 /
Turn Around Time'
'RUSH work needs prior approval.
Std 10days) 3-5 ❑a 24-48Hrs
� 0>
E�ITECH ���¢
%
` ENVIRONMENTAL LABORATORIES
' ..� 642 TamcoAd. Phone: [phone]
z Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
WWW,meritech fabs.com
Sample Location and/or ID #
.Sampling Dates & Times
PenonTakingSample{sign/Print):
:Lab Use Qply
Start
End
Comp?
Grab?
cot.
Test(s) Required
nice?
Yes No:
pH OK?
H OK?
Date
Time
Date
Time
Temperature.Upon
:. Receipt:
Method of
Shipment:
"" Dechlo6nation f<0.5 ppm) of Ammonia. Cyanide, Phenol
and TKN samples must be done in the field prior to preservation.
Comments:
Compositor#- : .
'D UPS
Pug
Fed Ex
Are t se results for regulatory purposes? Yes
No
Report results in: mg/L
[a': mgft Q ug/L
/� me: /
Relinquished b te:2,69
R iv
ate' Time: 1
_ Other
. ,.
R lin ate: % % T m
2— 4��I_re;7 �!
Received by:
9
me:
Time:
Relinquished by: Date: Time:
Received
VA-1
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