NCS000325_COMPLETE FILE - HISTORICAL_20190517

STORMWATER DIVISION CODING SHEET -:.-.
RESCISSIONS .
PERMIT NO.
N l.S ODD,
DOC TYPE
COMPLETE FILE- HISTORICAL
DATE OF
RESCISSION
YYYYMMDD

RA"',
FEHRGRA
ENGINEERING & ENVIRONMENTAL
UPS Tracking No. 1Z 651 395 03 5536 2297
May 13, 2019
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
MAY 17 2019
CENTRAL FILES
01NR SECTION
Re: Storm Water Discharge Outfall (SDO) Monitoring Report - April 2019
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for April 2019.
{ Please note the following:
• Storm water samples were collected during a representative storm event on
u
April 2, 2019.
• The results for zinc are above the facility's permit benchmark for both Outfall
No. 001 N and Outfall 002 S.
• The facility has already implemented its Tier II response and will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
a'N AJ -WIULAJ
Amy L. Trimble, CHMM
Environmental Scientist
ALT: d ld
Enclosures
cc: Mr. Marto Carter, Patch Rubber Company (with Enclosures)
0:IPatch Rubber Compary\19-105113A Final119-105 - NC Division of Water Quality - 2019-05-13 - April 2019 Storm Water 5D0
Report.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 1 f:815.235.4632 J www.fehr-graharn.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2012
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) M r i t Prh T.a h Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONE NO. 2( 52)53b-2574
SIGNATURE OF PER.MITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
i,
eSample
1:
CoHected'
I E I
,
1
1
1 i
�GTin-M
.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(ifycs, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Reuuirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appL)
Non -polar
O&GM-H '
(Method 1664 •
SGT-HEM); M
aos)L
'Total
Suslxnded
Solids
- .
pH
New Motor
On Usage
mo/dd/-Yr
MG
Inches
MZA
unit
al/mo•
Form SWU-247, last revised 21212012
Page l of 2

STORM EVENT CHARACTERISTICS:
Date 04/02/2019
Total Event Precipitation (inches): 0.13
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 Water Quality
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 or the person
or persons who manage th tem, or those persons directly responsible for gathering the information, the information submitted Is, to the
best of my knowledge ief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possi icy fines and imprisonment for knowing violations."
of Permittee)
(Date)
Form SWU-247. last relrscd 21212012
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Revised Date:
412412019
Contact: Amy Trimble
Report Date:
4/17/2019
Client: Fehr Graham
NPDES #:
NCS000325
221 E Main St
Project:
Patch Rubber Co.
Freeport, IL 61032
Date Sample Rcvd:
4/3/2019
Meritech Work Order #
04031982A Sample:
OF 001 N Grab
4/2/19
Parameters
Results
Analysis Date
Reporting Limit
Method
COD
45 mg/L
4/9/19
15 mg/L
EPA 410.4
Zinc, total
0.952 mg/L
4124119
0.010 mg/L
EPA 200.7
Meritech Work Order #
04031983 Sample: OF 002 S Grab
4/2/19
Parameters
Results
Analysis Date
Reporting Limit
Method
COD
60 mg/L
4/9/ 19
15 mg/L
EPA 410.4
"Zinc, total
0.133 mg/L
4124119
0.010 mg/L
EPA 200.7
I hereby certify that I have reviewed and approve these data.
Laborat ry Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

s.s.mrr Chain of Custody Record (COC)
IVPDES#: 5QCQ3a5
Client:r-
_=YY � Phone: L-gn)a35 7�� _ — --
Address: a3E. rpain .5f: Fax: (015) a35-4tv_;a'
Email: moa•►'ffebried Pa h"rrO_bbracfrm. corn
� {` ICF-_�, Project: PqhGh Aubbe-r C'.app2ny
PA:#:
Attention: m T Turn AroundTlme'
How would you like your report sent? 'RUSH work needs prior approval.
Circle all that apply: Email referred) , Fax, Mail Std 10 days) 3 - 5 Days 24 - 48 Hrs
ME CITE H NC.
1
ENVIRONMENTAL LABORATORIES
,+ 642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritechlabs.com
Sample Location and/or ID #
Sampling Dates &Times
Person Taking Sample (Sign/print):
_
Lab Usei Only
Start
End
Comp?
Grab?
Hof
Cont.
Test(s) Required
-on ice?
Yes / No
pH OK?
Cl OK?
Date -
Time
Date
Time
aF aoa
,:,_. p
4 (-0 is
k'"APmGr
I
a
�
Temperature Upon
Receipt: i
Method of
Shipment:
"" Dechlorina#ion (<0.5 Rpm of Ammonia, Cyanide, Phenol and TKN samples must be done in the field riar to preservation.'
Comments:
-
Compositor #
❑ UPS
Jug #
❑ Fed Ex
Are these results for regulatory purposes? Yes D� No ❑
Report results in: ' mg/L ba mg/kg ❑ ug/L ❑
❑ Hand Delivery
Relinqui he b Date: Time:
3
Received y: a Time:
® Other
L
Relinquiste: Time: sus
R ve by: Date: Time:
elinquished by: Date'. Time:
Receiv b -Cdja: j' tDStTim
J
ry

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfilling out thisform,please visit. httjr%jnortal.ncilenr.on;jkYcllfy %v jsii/nbilessw#eah-
Permit No.: /S,/ /Q/ Q/4/ 3 /2 / 5/ or Certificate of Coverage No,: D,/f./ 1-J- /_/—/_--/—%
I~acilityName: .-Patch Rubber Com n
County: Halifax Phone No. 252-536-2574
Inspector:._ NAac
Date of Inspection:"���
Time of Inspection: _ 0 ._ tYti ... -
Total Event Precipitation (inches):• 0 . \ 3
PH Se.5
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,
I some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least. 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
A%C
(Signature of Pert iittee or Designee)
Page 1 of 2
SWU-242, Last mcd4Cied 10/25/2012

.Outfall Description:
Outfall No. 001 . Structure (pipe, ditch, etc.) _Concrete pipe _
Receiving Stream:. Unnamed tributary to Roanoke River _
Describe the industrial activities that occur within the outfall drainage area:
North parking lot:, roof _drains
Z. Color: Describe the color of the -AID
3.
4. Clarity: Choose the mimher which hest descrihes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: s
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: j.
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
1,
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
t J 2 3 4 5
s
7. Is there any foam in the stormwater discharge? Yes
a
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
. f
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/depc
may he indicative of poIIutaitt exposure. 'These condii:ions warrant furtllrr invesQati
Page 2 of 2
swU•242,Lastmodified 10/25/2012

NCDENk
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfrllingout thisform,please visit:
1iT5l3:%��lortal.ricdeilr;ciie/avcb(wn/wsjsujiiiicl�ssw#tnb�t
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber _Company
County: Halifax Phone No. 252-536-2574
Inspector:
Date of Inspection:
Time of Inspection:.
Total Event Precipitation (inches):- O .V3"_ e4 � is
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,
Ii some permits do not have this requirement. Please refer to these definitions, if applicable.
1
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.
i 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 s erti�-fIiat t1lis report is accurate and complete to the best of my knowledge:
tune of Perm6ee or Designee)
Pagel oE2
swU-242, last modified 10/25/2012

1. Outfall Description:
Qutfall No. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed. stributar ito ,Roanoke River
Describe the industrial activities that occur within the outfall drainage area: -
Roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: -
N 1A
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): -
4. Clarity: Choose the number which best describes the clarity of the discharge, where I 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:
Q) 2 3 4 5
b. 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:
b 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 !a .
9. Is there evidence of erosion or deposition at the outfall? Yes iVo
10. Other Obvious Indicators of Stormwater Pollution:
List and describe iV \A-%
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be inw.licative oof iioliutant exposure. 'I'hcse condiflons warrant ffi—ri er investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012