NCS000209_MONITORING INFO_20190717

Alu
STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
NHS o o� a�
DOC TYPE
[I FINAL PERMIT
MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ �� I / � � �
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS000209 SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME Haynes Intemationat dba Haynes Wre Company 8 EC E i E D
PERSON COLLECTING SAMPLES) Angela Beck and Dennis Holden
CERTIFIED LABORATORY(S) James and James Environmental Lab #482 JUL 17 Li ;9
Lab #-----,CeNTRAL FILES
DWR SECTION
Part A: Specific Monitoring Requirements
COUNTY Henderson
PHONE NO. 82( 8 )393-1258
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
SampleOutfall Date
Collected
Flow (if �p
.
'
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Dyes ®no
(if yes, complete Part B)
Part B. Vehicle Maintenance Activity MonitoringRe uirements
Outfali
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
mgA
m
unit
al/mo
Form SWU-247, last revised 611212015
Page I of 2

STORM EVERT CHARACTERISTICS:
Date 6/25/2019
Total Event Precipitation (inches): •50
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Date)
Form SWU-247. lost revised 611212015
Page 2 of 2

JJEM AQUEOUS SAMPLE COLLECTION/LAB RE?ORT FORM (NC CFRT 482)
Reequlated by NGDEWDWO-Groundwater section
To assign test. label Shaded tree vAilh 5alnu?e type r3=grab!
CHAIN OF CUSTODY
LOCATION
�„��� ti
,� Z COUNTY
SPEUAL iNF7aR.W� T�,.
F
� 3
F15y 1
ID NO.
usz
oiVklS'M-
a4.4Oc
i
RA.5
comp Stem
sam ie time
CGEAP end
date/ time
t
COOLER #1-' #2
ur�z_ I
NOTE--:!`l: ^CC..7`lC 1E-tJqF1.,NC,"�.A ES DIET �.1..'! V'+_ I„ l�.. :iV:-J�`� -., !'.- �7�.�_
:;
--Ok AL COINI G111 i51 !'��i�r-71 S. i �i:: Y.� .w-4r`l:N;-::RfS.1 •1 i!Ti N
AMMONIA SAMPLES PRESERVED VVi T H H-SO_, pH=<<.G vES NO
.A^i'V-0N11A SAMPLES N=UTRALI7_ED Vv3Tri Na,S-0, Ciw< 0.1 --YES NO
FECAL SAMPLES PRESERVED WITH Na:SO, Cl=< D.' YES
.COLLECTED BY:
r'7 SAM,"IL SCOLLE TED ANDU YRESc,RVEG)A 1?lrE CC IJ �.ii�:��S 'Jlit=S ii�'r_'"ffi� iA/iS�:-. �•• +
REUNQUISHED BY
j DATE 1 TIME RECEIVED BY
r
{ ! SpUT SADAW w;S) tho
ANALYSES
i StJL S .
RES{D! �3
DA3E INIT .
F. COi_l
c€u1100mi
i
1
}
i
0
t I
SOD ppm
TSS ppm
4.91Ic
IL�15�-
Nm• pp1n
i
COND dJfllikO
i
TURB 7tu
MLSS ppm
MLVSS ppmAam
j
I
ALAPCALINITY
i
i
i
F i
By the above signeure i cerrtilry+ that all information is accurate to the bes, of my knowledge.
t OIVIm=N