NCS000354_MONITORING INFO_20200115

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STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
fvc
DOC TYPE
❑FINAL PERMIT
)� MONITORING REPORTS
0 APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ Da' u o � I -5
YYYYMMDD

RFOEIVED
JAN 15 2020
ATA
NCDEN CEN I Nr�L h ALES
Stormwater Discharge Outfall (SDO) DWR SECTION
Qualitative Monitoring Report
Forguidance on filling out this form, please visa
htto://jt)ortal.ncdenr.org/webLw wsfsu/njdessw#tab-4
Permit No.: JX/ __5_/Q/JJo �/_ /�/ or Certificate of Coverage No.:
Facility N me: �Li•— I NNLL
County: Phone No. VIA 0101
inspector: ✓i OYI-
Date of Inspection: 12 01 JUIcl
Time of Inspection: l =4
Total Event Precipitation (inches): 0 • 0_
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 _w
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
I 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
i from the local DWQ Regional Office.
By this sjgnature, I cgrtify that this repgrt is accurate and complete to the best of my knowledge:
ofPermittee or Designee)
is
PAO20P2
SWU-242, LOT MODIPIED 10/25/2012

I. Outfail Description: O
Outfall No. L 5tru 5e (pi e, ditch, etc) PQ� i�Un Torj • -
-� Receiving Stream: —
D�.�gs�cr_ibe the industrial activities that occur within the outfall drainage area: 1
2. Color. Describe the color of the discharge usin basic colors (red, brown, blue, etc.) and tint
[light, medium, dark) as descriptors. V 1!M-L fWOL I (r
3. odor: Describe an distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc): _tit
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
x 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:
0 2 3 4 5
6, Suspended Solids: Choose the number which best descrlbes the amount of suspended solids
in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
(1 J 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
10. Other Obvious indicators of Stormwater Pollution: �✓
List and describe --
Note: Low clarity, high solids, and/or the presence of foam, oll sheen, or erosion/deposition
may be Indicative of pollutant exposure. These conditions warrant further investigation.
PAGE 2 WZ is
SWU-242, LAST MODIRED 10/25/2012

0 0
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS NC-5� 35 7/1
FACILITY NAME
PERSON COLLECTING (S)
CERTIFIED LABORATORY(S) ----- Lab# _JAcL
Lab N
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR:
(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 laboratoAry.)
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COUNTY I-
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PHONE NO. (3_36)— -01;a
SIGNATURE OF PERMITTEE OR DESIGNEE
RE!2UtRED ON PAGE 2. 1
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Does this facility per -form Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _no
(if yes, complete Part B)
Part B. Vehicle Maintenance Activity Monitoring Requirements
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Form SWU-247, last revised 611212015
Pagel of

STORM EVENT CHARACTERISTICS:
Date bl11S
Total Event Precipitation (inches):
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
"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 elief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including tho-possibility 0 fines and imprisonment for knowing violations."
of Permittee)
0I
(Date)
Form SWU-247, last revised 611212015
Page 2 of 2

Chain of Custody Record (COC)
NPDES#:
1�(G•
E
MERIT CH INC,
1
Client:�P Phone:
W P1x12y1Lyu YA
Address: . Fax:
ENVIRONMENTAL LABORATORIES
0 Email:
642 Tamco Rd. Phone: [phone]
V
Project:
'' Reidsville NC 27320 Fax: [phone]
P.O.M.
Email: [e-mail]
Attention: GY s 4vii Turn Around Time*
1Ci
sent? 'RUSH work needs prior approval.
How would y2��z
WWW.mei'IteChfabs.COYYI
St lOd s} - s 24-48Hrs
GrdeaUthat applFax, Mail
Sampling Dates & Times
Person Taking Sample (Sign/Print}:
.fky{'�i>j�V jj�
J
;Lab Use°orily-
1
Sample Location and/or ID #
Start
End
Comp?
ffof'
Test(s) Required
OmEce? Yes:;pl'I;,QK?
Date
I Time
Date
Time
Grab?
Cont.
DD
Temperacure.Upon Remipt:
r*, } .• ,
='.e F ?=` �~•
Method of
Dechlorination <0.5 m of
Ammonia Cyanide, Phenol and TKN samples
must be done in the field prior to reservation. `•'
Comments:
_ .
Compaskor#�. -
Shipment:
;
UPS
Fed Ex
Are thep re r a o rposes? Yes No
Report results in: mg/t mg/kg ug/L �l
Hand Delivery
Relinquished by: Date:., Time:' ��11
/ l�'3 �� V � : Ui�M'1
fve Da? Ti : _
/�-� % ` U
Other
R llpq e by. `e� Time: f
�//
Recelved by. Date: Time:
Relinquished by: Date: Time:
Received by Lab: [ate:
Time:
0 0 W

Contact: Natasha Wicker
Client: Star Pet INC
801 Pineview Rd
Asheboro, NC 27204
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Report Date: 12/10/2019
Date Sample Rcvd: 12/3/2019
Meritech Work Order # 12031951 Sample: Stormwater # 699146 Grab
12/1/19
parameters
R__ esul
Analysis Date
Reporting Limit
Metbgd Qlalifier
BOD, 5 day
1.9 mg/L
12/4/19
2.0 mg/L
SM 5210 B G8, Q1
COD
34 mg/L
12/4/19
15 mg/L
EPA 410.4
Total Suspended Solids
19 mg/L
12/5/19
2.5 mg/L
SM 2540 D
pH
6.8 S.U.
12/4/19
1.0 -14.0 S.U.
SM 4500-HB
G8 Oxygen usage is less than 2 mg/L for all dilutions set The reported value is an estimated less than value
and is calculated for the dilution using the most amount of sample.
0 Q1 Holding time exceeded prior to receipt by the lab.
I hereby certify that I have reviewed and approve these data.
Laboratory Representative
40
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]