NCS000325_COMPLETE FILE - HISTORICAL_20200114

-• STORMWATER DIVISION CODING -SHEET -.-.
RESCISSIONS .
PERMIT NO.
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�COMPLETE FILE , HISTORICAL
DATE OF
RESCISSION
❑ �W V � I l
YYYYMMDD

AW-1 M
FEHRGR
EN@NEERING & ENVIRONMENTAL
UPS Tracking No. 1Z 651 395 03 5700 0647 ,EcF-NT--0
.January 8, 2020 3t414 Z4N
LES
Division of Water Quality CDC CT ON
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Storm Water Discharge Outfall (SDO) Monitoring Report - December 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 December 2019.
{ Please note the following:
• Storm water samples were collected during a representative storm event on
CD
December 17, 2019.
a
The results for zinc are above the facility's permit benchmark for both Outfall
No. 001 N and Outfall No. 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,
1-1Md
Amy L. Trimble, CHMM
Environmental Scientist
MLT:dep
Enclosures
cc: Mr. Mario Carter, Patch Rubber Company (with Enclosures)
0APatch Rubber Company120-105 - Environ, outsourcing AnnuallPA Final120.105 Patch Rubber 2020.01.07 - December 2019
Storm Water SDO Report.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORM1VATER DISCI{ARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITY NAME Patch Rubber Company _
PERSON COLLECTING SAMPLE(S) Mar 1 n Carter, _
CERTIFIED LABORATORY(S) MPri t-_e rh l,ab Lab 4
Lab #
Part A: Specific Monitoring Requirements
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.)
COUNTY Halifax
PHONE NO. 2( 52 )536-2574
EaRE
NATURE OF PERMITTEE OR DESIGNEE
OUIRED ON PAGE 2.
•
Dat
CollectedQ
Total
pp
TotalSample
•�
�1•��f
t
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date -
Sample
Collected
50050
00556
00530
00460_
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease..
(if appl:)
Non -polar
O&G/TPH
(Method 1664.
SGT-HEM),.if
appl.
Total-
Suspended
Solids
pIl
New Motor
Oil Usage'
mo/dd/yr
MG
inches
m /l
in/1
unit
al/mo
Form SWU-247, last revised 21212012
Page l of 2

STORM EVENT CIIARACTERISTICS:
Date 12/17/2019
Total Event Precipitation (inches): 0•1
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
"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."
�f" \ � 01 /08/2020
(Signature of Permittee) (Date)
Form SWU-247, last revised 212120I2
Page 2 of 2

Contact: Amy Trimble
Client: Fehr Graham
221 E Main St
Freeport, IL 61032
Meritech Work Order # 12181987
Parameters
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Results
Report Date: 1/6/2020
NPDES #: NCS000325
Project: Patch Rubber Co.
Date Sample Rcvd: 12/18/2019
Sample: OF 001 N Grab 12/17/19
Analysis Date Reporting Limit Method
COD 20 mg/L 12/23/19 15 mg/L EPA 410.4
Zinc, total 0.210 mg/L 12/27/19 0.010 mg/L EPA 200.7
Meritech Work Order # 12181988 Sample: OF 002 S Grab 12/17/19
Parameters Results Analysis Date Reporting Limi Method
COD
20 mg/L
12/23/19
15 mg/L
EPA 410.4
Zinc, total
0.101 mg/L
12/27/19
0.010 mg/L
EPA 200.7
I hereby certify that I have reviewed and approve these data.
Labo ato6 Represent tive
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

S-9 I91f Chain of Custody Record (COC)
NPDESN: I�IC:`j�X7�v�J
Client:-- t-chr(zyaf-C.r Phone:1BIL-5) 55..7 43-
Address:_a9l F. f1Tdtr) fr". _ Fax:,(815)d_ 400 U
0. mfafe fchr-r.7nxlYer".Can-)
1='rr'fr ��M- LQIQM Email; mcurfnrd x1uvJvb��r. Wrn
r�r ^L � _ _ _ _ Project: AL
P.O.#:
Attention: m-,'T Turn Around Time*
How would you like your report sent? *RUSH work needs prior approval.
Circle all that apply: Email referred), Fax, Mail Std 10days) 3-5 Da"s 24 - 48 Mrs
MEIIIUTECIl 11p tiii`i11C
s ENVIRONMENTAL LABORATORIES
u 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 Use Only
Start
End
Comp?
Grab?
sofTest(s)
Cont.ot
Required
On Ice?
e / No
pH OK?
Cl OK?
Date �
Time
Date
Time
1.
OF WR�'
21t,��q
�.s-rQ
�z��-►j�gz:o2p
C�
��
—
Temperature Upon
Receipt-.
�J
Method Of
Shipment:
**' Dechlorinatinn <0.5 m of Ammonia Cyanide, Phenol and TKN samples must be done In the field prior to preservation. *•*
Comments:
-
Compositor #
—
❑ UPS
Jug q �-
❑ Fed Ex
Are these results For regulatory purposes? Yes R No ❑
�,,
Report results in: mg/L L d mg/kg ❑ ug/L
ED Hand Delivery
Relinquished by Date: Time:
Received b /Q�1g: Time: 0
C4JDate;
UJ Other
- ;
! V
Relinquished by Date: r Time: �L
�.... O
-9
ecely Time:
Relinquished y: Date: Time:
Received by Lab:
^ R ate: Tim_ e:aLfo
.� �

4
NC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http://portal.ncdenE.fie/web/3ya/ws1sulnpdessw#tah-4
Permit No.: N/jC/-&./Q/-L/&-j/_Z/ 5/ or Certificate of Coverage No.: NI-C&/—/_/`/-J_/_/
Facility Name: Patch Rubber QQM@gny
County: Halifax Phone No. 252-536-2574
Inspector:$
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): Q. 1 p �k ("0
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Z) Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during o "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
f 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
I obtains approval from the local DWO Regional Office.
By this signature, I �qtify that this report is accurate and complete to the best of my knowledge:
Cure of/15ermittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 0p2 Structure (pipe, ditch, etc) Concrete pipe
Receiving Stream: _Unnamed tributary to 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 \P-,—_-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N kPs
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
0 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 S is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes C No
8. Is there an oil sheen in the stormwater discharge? Yes lea
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
Listand describe LA �'A
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

HCDENR
Stormwater Discharge Outfail [SDO]
Qualitative Monitoring Report
For guidance on filling out thisform, please visit. http://portal.ncdenr.orglweblwa/ws/su/npdessw#tab-4
Permit No.: /-Q/-a/2-/ / or Certificate of Coverage No.: /C�/_/_/_/_/`/_/
Facility Name: Patch Rubber Company __,!__•__
County: Halifax Phone No. 252-536-2574
Inspector: MC sk �.c
Date of Inspection:
Time of Inspection: V.
Total Event Precipitation (inches): O • \?R (o .0
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
EAYes ❑ 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. 141ost 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.
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 per•mittee 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 th t this report is accurate and complete to the best of my knowledge:
ture of �mittee or Designee)
Page 1 of 2
Swill-242, Last modified 10/25/2012

-- - �: Outfall-Descriptionr _._. _.� _......._..._ - ._._. _. __u _................ ...._u-� ... - _.
outfall No. 001 Structure (pipe, ditch, etc.) Concrete pipe
g Roanoke River
Receiving Stream:, Unnamed tributary ta., Roa. _._.. ,.. ___...,....,
Describe the industrial activities that occur within the outfall drainage area:
_ North parking -lot --roof drains
2. Color: Describe the color of the Jischarge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: 0_ C-oxa2 -- C'.16-A&
3. Odor: Describe any disf'net odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): I" 4911
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and S is very cloudy:
(9 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
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:
V 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
69
8. Is there an oil sheen in the stormwater discharge? Yes
V
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 df pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
sWU-242. Last modified 10/25/2012