NCS000592_MONITORING INFO_20190209

STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
ol
nlL�; �/uo a
1'
DOC TYPE
❑FINAL PERMIT
�, MONITORING REPORTS
❑ APPLICATION
0 COMPLIANCE
❑ OTHER
DOC DATE
0 0,)09-
YYYYMMDD

&a510
Environmental
Quality
Stormwater Discharge Outfall (SD4)
Qualitative Monitoring Report. :
For guidance on filling out this.rorm, please visit https_//deg.nc.>:ovlaboutldiv_iions/ener>;y-mineral-land-
resources/ever -mineral-land- ermits/Stormwater- ermits/nn des-industrial-sw#tab-4
Permit No.: NICI S/ O/ D/ O/ 51a1 24 or Certificate of Coverage No.: N/CIGI-1 /_l_l hl
Facility Name: co(pepefi' pp Roo�taAe ?oe.p A S
County: _99AI �Q k Phone No. _ Q5-1- 509 • (1,070
Inspector:
Date of Inspection:
Time of Inspection: Er-FIVED
��
JAN092019
'total Event Precipitation (inches): (•rCENTRAL Fll_Ec
DWR SEc7,10 '
All permits require qualitative monitoring to be performed during a "measurable storm event."
_�
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 pennittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permitter obtains approval from the local DFMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permitter or Designee)
1. Outfall Description:
Outfall No. i Structure (pipe, ditch, etc.): Wt ek t'o t�! 0.. eq _
Receiving Stream:
ChaCt,
Describe the industrial
--- LO"6a.r w ` u —
Page l of 2
SWU-242, Last modified 07/28/2017

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Cleap
3. Odor: Describe any distinct odors that the discharge may have (i.c., smells strongly of oil, weak
chlorine odor, etc.): NoNe
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
0 2 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:'
�1 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
O 2 3 4 5
7. Is there any foam in the stormwater discharge? o Yes O No.
8. Is there an oil sheen in the stormwater discharge? OYes 0 No.
9. Is there evidence of erosion or deposition at the outfall? O Yes 1 No.
to. Other Obvious Indicators of Stormwater Pollution:
List and describe N e
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, fast modified 07/28/2017

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc.gov/about/divisions/cnergy-mineral-land-
resourceslenergy-mineral-land-permits/stormwater-permit npdes-industrial-sw#tab-4
Permit No.: NICIJI0 0 O/_Sj �/ or Certificate of Coverage No.: N/CIGI
Facility Name: coin i' pt Rmoo4<< 1A4 S
County: Phone No. L5 a1 561 - (p0i O
Inspector:
Date of Inspection:
Time of Inspection:
K
Total Event Precipitation (inches): rJ
All permits require qualitative monitoring to be performed during a "measurable storm event."
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 DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. I Structure (pipe, ditch, etc.): N�e4kna area,
Receiving Stream: I� _
Gl.flc�Cor k�a Cr" C,6,S C SiTeaa, i�A 1zDarintc. lzwe�' t wl>a
Describe the industrial activities that occur within outfall [[drainage areas: l
TleQAeL wat S� ra,�� . 100-A►.Y4 QNfj( t)�1�oa.rQie lot Or
Pagel of 2
SWU-242, Last modified 07/29/2017

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: CI P
3. Odor: Describe a y distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): o Pe
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
bl 2 3 4 5'
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
bi 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
lO 2 3 4 5
7. Is there any foam in the stormwater discharge? O Yes ®No.
8. Is there an oil sheen in the stormwater discharge? QYes & No.
9. Is there evidence of erosion or deposition at the outfall? o Yes p No.
10. Other Obvious Indicators of Stormwater Pollution:.
List and describe �00 e—
_ T
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 07/28/2017

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS t>aoS�.
FACILITY NAME Co (ve Xq,IA'Ac- ILQ i S
PERSON COLLECTING SAMPLE(S) _Rtc,k F4roj6 . M.
CERTIFIED LABORATORY(S)E*,tyt'oNr-.Et.}E 'ZrJC. Lab # A'TI
Lab 9
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: a4>t%
(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 OJ Pgk
PHONE NO. (257.) 56_1-L9010
SIGNATURE OF PERMWTTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
No.-,
Date
'Sample
ected
50050....
Total
} faw.: if a
TotalCo
Rainfall
MG ..
inches
17t. to l$
1.1
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes /o
(if yes, complete Part B)
Part B. Vehicle Maintenance Activi Monitoring Requirements
Outfall
IJate , '
_50050` _
00556
00530_
-0046
r
No:
5amole ,
Total Flow ,'
Total <
Oil & Grease
Non,pola'r
Total
pH
New Mntar
"
'Collected�kF
(if applicable)
Rainfall
(tfappl:}
O&GITPH
Suspended=
_Oil Usage
w
(Method 1664
S011ds
t
_'-
`2n"�*
�.
t�
r
.�trr�
-
'�` r
SGT AE1I}, if �
". *x�.
` �
�;
^.t �r"'Ri
_ F
:•r '_
�}}�•
1-.i -^. S'.
.�- ,-..
!
-q. !
�
�. �,
}� � �
..-1
_- � ,
4✓ J;}.�
t : O: +{ 'i
i{•4'-C.
i. ei
'ALA
app
,zt-.. .i
4_71.:L} _ L. 5�.
fit- .. J..,
me/ddl n
MG,
inches
m' S
;�
i1i `r - =
'iiriit ;
aUmo=:
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 1 ;J10 t I r
Total Event Precipitation (inches): I e ✓
Event Duration (hours): _ tJ. �krS (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."
(Signature of P
1 -A !q
(Date)
Form SWU-247, last revised 2/2/2012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year 71
Individual NPDES Permit No. NCS[ala®Q®❑; or
Certificate of Coverage (COC) No. NCG❑❑❑❑❑❑
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: C.-V 1kom*441e.
County: A,:kuax
Phone Number: Sb'l Total no. of SDOs monitored _
Outfall No. I
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ®.
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No;q
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑ f
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
17
:lja3 S `'EFcr .� ^',,.:•+�:.: -R.. _ r �- M: y;= ve i r, - -3^ '-
fY_
s•
T
i.lotal
�-!" -� t�.- �`
Yam' ..sl
`'t£-•}j.'.c
�• Fes:_:
# •3'T•
:i •may
f-
Tr -��s'
J ,I,_�.!i•°.-r.. -ii
-V:.n
}-
x+ e rx e
a ;�
v7.:}_.J...
w x
Rainfall;
n'"c'f i�`
r. :��"�`
apt;;• MQ�L
,r
.., •'L' s;-
X"'
�.'
/^�(,, ..�
:��e:JY
y.�. .tiy .}3
Oct ' r
_,
t r`2..
a _y-e
H:
- r."'.
pinches
} Q'�-
t-.i...
�
.b,i..o•.-...2i ..+.�:.^.�• �-
,.-r.r z�.c
7 h�
�_C •�•�a=.�Y '.S
wp
- d�,a�:.s
i�. /L iY.o-k r.i
_ _
"� r'�"Y.'Y^S-
.].;i;.�r^4�n
`�1�K 41
Benchmark
NIA
j D
0.3
O� 05
p 0too
Co-
�_.,
:Date:Sample,.
Collected-*-
= i;mladryy,�a,
.oa.1
.09;.
3.3
SWU-264 - Generic Annual DMR
Last revised 5/17/2013

Additional Outfall Attachment
Outfall No. �!
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was. this outfall ever in Tier 2 (monitored monthly) during the. past year? Yes.❑ No-®
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑ ,
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
t
M.,qy7
'r.:."5;:=';F� "F-
t�' " ,
•'s 'dy"`�het'k_
^.'!]"`f- }.-
F %- �.
�€ .� Y.Y.
i
_f i�-� ryi
! ,?
;n � F e coif
r �Yw�'
_
iR �' :'.+t �`•f'v`4'F
3• ?is J - 7 4
F -
,z
`; £; -3.w'
E Ta .�
..-.F.,.:41
"_ _ ..!-
.•;�" fsr -.�:
:'•, v,
t,.A''e34S --3' ..R:
9.'f't�TF!'�'..ti �2
s. 't '::y_a "I�; -
Akfi
€ g--;+1�'?`'?'--
2ui 'b
"ma's, !"
._ .. �"?iz_ .:f ._
•4,X - 2 �;.-ate'! .j_:"
s A z FxJysu
I A5,3_.�-
. �`^�'' £ A. 1�
"{
- ,^_'`4`�-''
z a,4 y -'id
< # .
i l..'- fir.F.W
#:_.:J __�;� X Vi�C
' � s9:rr
- z
> ?i_
1i �-tr�
`^
n l G l "it. - ;.•
�% ".�_ .�-�',',C
5•,.j�c.k.:�C:ztA}
,,-ir .: a
.+ t. "1
:� fi-v"i""I.�
s2
y9...
7r'.•'.r.fr"C. 1�
fit!• it,w 4 f7'
"I
- .�`•;� 3
.��.`- '+, �iili 'a(
�3�. .r-,i��._t _�It'`�C
e�-+�±.t .[ea'`:
4'}�
°}'rts _j_ R .Z
i'
�'?`.Y
L.� _
-�A"� pis
.�.,'a.T
I:
,1 ..y-��5tf
L: +c� - � -
' �V'
�:.s
S_ C- rt'. 'y� r..-k,?e'`�•:�
: Y F .�*•
j .t,<' _•• r'dF,},-�•.!.
1i�.'i='^'�S•
J' ..Z
1- `�.s�+�'-�`�: '
-.; l ....�E
rs� ?. .I`f�.
---K�. '•�6.!`!i .! "L`-
a
Y:_
- O' „-
{' -
l ^`
a �
SWU-264 - Generic Annual DMR
Last revised 511712013

I certify; under penalty of law, that this document and all attachments were prepaied under my direction or supervision in accordance with a
system designed tG 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; 'e the
best of my knowledge and belief, true; accurate, and complete. I am aware that there are significant pQna€ties for submitting faise information.
including the possibility of fines and imprisonment for knowing violations."
5igna
Date
For questions, contact your local Regional Office:
DWO Regional Office Contact Information:
ASHEVII,I.DREGIONALOFI'IGE
FAYETTEVILLE.;REGIOi\AUO_ FFICE
MOORESVMLE?REGIONAL`OFFIC-F
2090 US Hi-hwav 70
Green Strut
610 East Center avenue/Suite 301
Stizannanea, NC 28778
Svstel Building Site 714 ;
\-looresville. \C 281t
[phone]
Fayetteville. \C 28301-5043
[phone]
[phone]
RALEIGHIREGIOyAL=OFFICE
WASHPIGTONAEGION-ALOFFICE
WMMLNGiON REGIONAL:OFFICE
3840 Barrett Drive
943 'kN ashinQton Square N-iall
127 Cardinal Drive Exiension
Raleigh, NC 27609
Washington. NC 27S89
Wilmingion. \,C 28405-2845
[phone]
(252) 946-64S!
[phone]
Y�%'_ 4T_ QN- LEM AEGIONA -'OFFICE
CENTRAL_D_FFICE
383 Waughtovvn Street
1617 Mail Sen ice Center
To preserve, protect
Winston-Salem. \'C 27107
Raleigh, \C 27699-1617
and ehhanee
336 771-5000
( )
(919) 807-630')
No►rh Carolina's water...°
SVVU-23L - Generic- Annual DMR
Lasrrsrrse�" /i7i2Y.

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr. Page 1 of I
Greenville. NC 27858
environment) inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
CHLORINE
CLIENT: 27I Week-
UV
pHCHECK (LAB)
:ULPEPPER WOOD PRESERVERS
❑ NONE
P
P
P
P
P
CONTAINERTYPE, PIG
,TTN: BILLY RODGERS
I
CHEMICAL PRESERVATION
262 W. 10TH ST.
:OANOKE RAPIDS INC 27870
A
C
A
A
A
A -NONE D-NAOH
o
488) 507-6070
z �
Z
it
Cr
LU
C B- HNO3 E- HCL
20
y F
o
z
Uj C- H2SO, F- ZINC ACETATE/NAOH
COLLECTION
�,
o o
Q
8
w
OU
F
3<
Z
G . NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
Stormw•ater (#I, Grab)
�}����
f'� u,
4
$_:``
:..
s`
CLASSIFICATION:
❑ WASTEWATER(NPDES)
Stormwater #2 Grab
( )
p
x�Ci�ll O
i ° 1,
{
1
1
' Z
DRINKINGWATER
LlDWOJGW
SOLID WASTE SECTION
CHAIN OF CU DY (SEAL) MAINTAINED
DURI VGSHI ENTIDELIVERY
N
SAMPLES COLLECTED BY:
(Please p4nt)
�-
SAMPLES RECEIVED IN LAB AT La -C
RELINQUISHED BY (SIG.) ( P
R)
DATE11nME
R ED BY (SIG.
D TFJiiME
COMMENTS:
RELINQUISHED BY (SIG.)
DATEITIME
REtEI76 BY V
DATE/TIME
.+
Qric ( p4ees wer~ tizA '
& A1,g "
RELINQUISHED BY (SIG.)
DATEJIIME
RECEIVED BY (SIG.)
DATEMME
p ; G
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
FORM as Grab sample in the blocks above for each parameter requested. N2 361351

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and inlormed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of'40 ml. Voladies Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible duo to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection belore being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked f'or proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be belore any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Crab Sample should be placed in the box for all requested -parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Col lection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Colilorm and Enterococci samples have a holding time of6 hours from time ofcollection to time ofanalysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dales in order to meet the required holding fimes.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. I ['any chemical should get into your eyes, on your skin or on your clothes, Hush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

RMOT(BIMEM % jilcorpumigo
CULPEPPER WOOD PRESERVERS
ATTN: BILLY RODGERS
2262 W. 10TH ST.
ROANOKE RAPIDS rNC 27870
ID#: 271
DATE COLLECTED: 12/10/18
DATE REPORTED : 12/31/18
REVIEWED BY: ry
Storwwater
Stormwaler
Analysis
Method
PARAMETERS
(NI, Grab)
(i12, Crab)
Date
Analyst
Code
BOD, mb/I
3.1
C2.0
12/12/18
IIMM
521011-11
COD, nng/l
24
G 20
12114/ 18
SE 1
U8000-79
Total Suspended Residue, ingll
3.3
¢2.7
12/13/18
Mil
25401)-11
Arsenic, mg/l
0.027
0.239
12/28/ 18
MTM
311311-10
Total Chromium, nag/1
0.021
0.019
12/20/18
LFJ
EPA200.7
Copper, mg/1
0.092
0.041
12/20/18
LFJ
EPA200.7