NCS000592_MONITORING INFO_20190513

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STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
Nl.,� OVV
DOC TYPE
❑FINAL PERMIT
Y, MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
3
❑ � �' CI v " l
WYYMMDD

?.a
RECEIVED
Environmental
tal MAY 1 a 2015
Stormwater Discharge Outfall (SDO) CENTF,�AL F14-ES
Qualitative Monitoring Report DWR SECTION
For guidance on f lling out this form, please visit https://deq.nc. ov/about/divisions/energy-mineral-land-
resources/ener -mineral-land- ermits/stormwater- ennits/n des-industrial-sw#tab-4
Permit No.: N/Cl-C�l dl 0101.51 oil dZ or Certificate of Coverage No.: NICIGI 1 l_I_I l_I
Facility Name: C0i Pepe l' v �NG a,DicS
County: 9Qi, Pp, k Phone No. as a ,
Inspector: R %Gk �arN�ctir�
Date of Inspection: 4 1 a l i q
Time of Inspection: oZ -'0b p. M.
Total Event Precipitation (inches): RECEIVED
MAY 232019
All permits require qualitative monitoring to be performed during a "measurabl'%&e Ulgljtt"
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.): FefdN-irtyyl Cq-,2c%
Receivin Stream:
-6,4,osioAk C dAss C" kmozqov &5, a
Describe the Indus rial activities that occur within the outfall drainage area:
Page 1 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: (JeA CL;+4N cGeye DA(W f es kue.
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): 6)00e
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 U11 3 4 S
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 0 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:
i 3 4 5
7. Is there any foam in the stormwater discharge? O Yes m "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 OD No.
10. Other Obvious Indicators of Stormwater Pollution;
List and describe NbN 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, Last modified 07/28/2017

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance onfilling out this form, please visit https://deci,nc.gov/about/divisions/cncrpy.-mineral-taiid-
reso urceslenergy-m i neral-land-permits/stormwater-permits/npdcs-industrial-sw#tab-4
Permit No.: NIC/S /J lD l vl 5 l_Jql or Certificate of Coverage No.: NIC/Gl_I_I_I I_I ,/
Facility Name: I�Mgcke, R�c,,PA r,
County: 14 �► k Phone No. AQ - 501 - (Q00
Inspector: _':Rki YMW6,M
Date of Inspection:Time of Inspection: X DD
Total Event Precipitation (inches)
at
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 treasurable 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 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. _O Structure (pipe, ditch, etc.): Tx,--ktiLA ►tra 0.CeGi
Receiving- Stream:
Usjcl,tadVA4e "-- Oast' C ske&m. _'ia 4a
Describe the induct al activities that occur within the outfall drainage area:
Page l of 2
SWU-242, Last modilied 07/2812017

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: (' IeoC
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): _000Z _�
4. Clarity: Choose the number which best describes the clarity of the discharge, where l is clear
and 5 is very cloudy:
D 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:
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:
V 2 3 4 5
7. Is there any foam in the stormwater discharge? O Yes 0 No.
8. Is there an oil sheen in the stormwater discharge? OYes ® No.
9. Is there evidence of erosion or deposition at the outfall? o Yes ® No.
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 of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 07/28120f7

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches):
Event Duration (hours): QKV-, (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 Permittee)
y/a�r9
(Date)
Form SWU-247, lust revised 21212012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 00705CP,
FACILITY NAME C l ;' s2Las
PERSON COLLECTING S MPLE(S)-ku,t, &CM6 n.
CERTIFIED LABORATORY(S) 6tutpD►jmep4 J. iNc Lab # a, l
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: (aDM
(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 �� k
PHONE NO. T "ti"'l - 0O
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
50050
Total
Flow if a
Total
Rainfall
mo/dd/ r
MG
inches
-4l as I ict
��. i
I
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
yes ✓no
Outfall
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
m
m
unit
at/mo
Form SWU-247, last revised 21212012
Page I of 2

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual_ Update DATA REVIEW FORM
Calendar Year aplc{
Individual NPDES Permit No. NCSJ
Certificate of Coverage (COC) No. NCG
Z
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: l eC`
County: NJ K
Phone Number: (d5l ) 525-1
Total no. of SDOs monitored d-
Outfall No. � I
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ Nog
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
Total
Rainfall,
inches
Parameter,((units)
coI)
b itr*
�!
Arse t4w-
m ��1+1
�fOV.%%a %
I<
Cctfe"r
I
s
►ac�ct'c�
Benchmark
N/A
p
11ao
V0134
v .c)10
.1 Dc>
Ca`
Date Sample
Collected,
mmiddiyy
9
13
SWU-264 - Generic Annual DMR
Last revised 511712013

Additional Outfall Attachment
Outfall No. aZ__
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 ❑ NOR
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
Total
Rainfall,
inches
Parameter, (units)
R
Val
C (i �
�t' $� N �C
C�P0M %uw'
[.q Pe r'
�5S
i
Benchmark
N/A
O,
6,C
p_O p
7�
-a(
Date Sample
Collected,
m mld dlyy
SWU-264 - Generic Annual DMR
Last revised 511712013

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 possitjity of flnes and imprisonment for knowing violations."
Signature
Date 5f'
For questions, contact your local Regional Office:
DWQ Regional Office Contact _Information:
SHEYILLE REGiOIYrAL OFRI'C
ACYETTEviLLE REGIONAL OFFIC
NFWRKSVji0AETkPGIONAL OFFIC
225 Green Street
610 East Center Avenue/Suite 301
2090 US Highway 70
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
910 433-3300
LEIGH REGIONAL OFFIC
XSHINGTON REGION'ArI OFFIC
LMINGTON REGIONAL QFFIC*
943 Washington Square Mall
127 Cardinal Drive Extension
3800 Barrett Drive
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
INS SON-SAL�EM REGIONAL OFFI'C
FENTRTAL OFFIC
1617 Mail Service Center
Raleigh, NC 27699-1617
"To preserve, protect
and enhance
585 Waughtown Street
Winston-Salem, NC 27107
336 771-5000
919 807-6300
North Carolina's water..."
SWU-264 - Generic Annual DMR
Last revised 511712013

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085. 114 Oakmont Dr. Page I of
Greenville. NC 27858
environment 1 inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
CHLORINE
CLIENT: 271 Week: 16
UV
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pH CHECK (LAB)
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CONTAINER TYPE, PIG
'ULPEPPER WOOD PRESERVERS
NONE
,TTN- SILLY RODGERS
262 W. IOTH ST.
CHEMICAL PRESERVATION
,OANOKE RAPIDS NC 27870
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SAMPLE LOCATION
DATE
TIME
Stormwater (#1. Grab)
`�W W.
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CLASSIFICATION:
❑ WASTEWATER(NPDES)
Stormwater (#2, Grab)
i'al,
A:t;,
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LlDRINKING WATER
DWRIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURINGCIPMENT/DELIVERY
N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT _C�-( °C
RELIN ISH D BY (SI .) (SAMPLER)
DATEMME
RECEIV
B (SIG.)
COMMENTS:
3i
�ATEMME
I U
p
RELINQUISHED BY(SIG.)
DATEfflME
RECEIVED BY (SIG.)
'DATFAME
/-
RELINQUISHED BY (SIG)
DAME
RECEIVED BY (SIG.)
DATEMME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
FORM #5 Grab sample in the blocks above for each parameter requested. N 0 363029

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 informed 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 Slate 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 ofcollection 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. Volatiles 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 due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before 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 for 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 before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for al l requested parameters. Grab lemperatu Fes
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 Collection
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:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. 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 dates in order to meet the required holding times.
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. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

Emkomad Ala kwPumbd
114 OAKMONT DRIVE PHONE [phone]
GREENVILLE, N.C. 27858 FAX [phone]
ID#: 271
CULPEPPER WOOD PRESERVERS
ATTN: BILLY RODGERS
2262 W. 10TH ST. DATE COLLECTED: 04/02/19
ROANOKE RAPIDS ,NC 27870 DATE REPORTED : 04/24/19
REVIEWED BY:
Stormwater Slormwater Analysis Method
PARAMETERS (#1, Grab) (#2, Grab) Date Analyst Code
BOD, rug/1 8.2 <2.0 04/03/19 TCW 5210B-11
COD, mg/l 36 <20 04/05/19 SEJ H8000-79
Total Suspended Residue, mg/I 13 <2.9 04/04/19 JTH 2540D-11
Arsenic, mg/1 0.010 <0.005 04/09/19 MTM 3113B-10
Total Chromium, mg/I <0.005 <0.005 04/08/19 LFJ EPA200.7
Copper, mg/1 0.098 0.003 04/08/19 LFJ EPA200.7