NCG080134_DMR_20200313

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG080000
Date submitted 03!13/20
CERTIFICATE OF COVERAGE NO. NCGO8 0 1 3 4 SAMPLE COLLECTION YEAR 2020
FACILITY NAME Pilot Travel Centers LLC#58 SAMPLE PERIOD • Jan-June n July-Dec
COUNTY Northampton or n Monthly' _ (month)
PERSON COLLECTING SAMPLES Craig Richardson DISCHARGING TO CLASS _ORW HQW _Trout I IPNA
LABORATORY Pace National Lab Cert.# 375 RECEIVE nZero-flow nWater Supply fSA
Comments on sample collection or analysis: I"` ■Other c;Nsw
MAR 2 3 2020
PLEASE REMEMBER TO SIGN ON THE REVERSE -
CENTRAL FILES
Did this facility perform Vehicle Maintenance Activities using more than 55 galldnitt ec- diil` er month? yes I I no (if yes, complete Part A)
Part A:Vehicle& Equipment Maintenance Areas Monitoring Requirements (If applicable) No discharge this period'
Outfall No. Date Sample Collected' 24-hour rainfall amount, Non-Polar Oil &Grease Total Suspended Solids, New Motor or Hydraulic Oil Usage,
(mo/dd/yr) Inches3 mg/L mg/L gal/mon
Benchmarks _ - 15 100 or 504 -
Parameter Code - 46529 00552 C0530 NCOIL
' Monthly sampling(instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
°See General Permit text,Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example,do not report Below Detection Limit, BDL, <PQL, Non-detect, ND, or other similar non-
numerical format. When results are below the applicable limits,they must be reported in the format, "<XX mg/L",where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Page 1 of 2

Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals(If applicable) ri No discharge this period2
Outfall Date Sample 24-hour rainfall Sample Collected' Total Suspended pH, Non-Polar Oil&
No. Collected' amount, mo/dd/yr Solids, Standard units Grease,
(mo/dd/yr) Inches' mg/L mg/L
Permit Limit - - - 100 or 504 6.0—9.0 15
Parameter Code - 46529 - C0530 00400 00552
001 01/14/20 0.91 01/14/20 20.0 6.86 <5.00
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark,you must implement Tier 1, Tier 2,or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES,HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR,including all"No Discharge"reports within 30 days of receipt of the lab results(or at end of monitoring period in the
case of"No Dischorqe"reports)to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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."
3 - Ia -
Si tur f i ee Date
Permit Date:11/1/2018-5/31/2021 SWU-248,last revised 11/1/2018
Page 2 of 2

ATTACHMENT II
Laboratory Certificates of Analysis
and Chain-of-Custody Documentation

aceAnaiyticai• A \ A L Y T I C A L REPORT
Nationu Confer nor 7es!inq&Innovation January 21, 2020 '' 9 '
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Pilot Apex Environmental
Sample Delivery Group: L1179579 isi
Samples Received: 01/15/2020 5Sr
Project Number: 768490-047
Description: Pilot 58 6Qc
i Site: PILOT 058
IllReport To: Robert Wagner
7724 Garland Circle cAl
Roanoke,VA 24019
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Entire Report Reviewed By: futLI /
Pam Langford
Project Manager
Results relate only to the items tested or calibrated and are reported as rounded values.This test report shall not be
reproduced,except in full,without written approval of the laboratory.Where applicable,sampling conducted by Pace
Analytical National is performed per guidance provided in laboratory standard operating procedures ENV-SOP-MTJL-0067 and
ENV-SOP-MU-0068.Where sampling conducted by the customer,results relate to the accuracy of the information provided,
and as the samples are received.
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ACCOUNT: PROJECT SDG. DATE/TIME: PAGE:
Pilot Apex Environmental 768490-047 L1179579 01/21/20 09:51 1 of 10

TABLE OF CONTENTS ONE LAB.NATIONWIDE.
Cp:Cover Page 1
Cp
Tc:Table of Contents 2
Ss:Sample Summary 3 2Tc
Cn:Case Narrative 4
3
Sr:Sample Results 5 Ss
OUTALL 001 L1179579-01 5 4
Cn
Qc:Quality Control Summary 6
Gravimetric Analysis by Method 2540 D-2011 6 SSr
Wet Chemistry by Method 1664A 7
6
GI:Glossary of Terms 8 Qc
Al:Accreditations& Locations 9 7
GI
Sc:Sample Chain of Custody 10
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9
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Pilot Apex Environmental 768490-047 L1179579 01/21/20 09:51 2 of 10

SAMPLE SUMMARY ONE LAB.NATIONWIDE. Ilk
Collected by Collected date/time Received date/time
OUTALL 001 L1179579-01 GW Craig Richardson 01/14/2011:20 01/15/20 09:00 t Cp
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time 2
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Gravimetric Analysis by Method 2540 D-2011 WG1411760 1 01/16/20 00:05 01/16/20 01:13 MMF Mt.Juliet,TN
Wet Chemistry by Method 1664A WG1413195 1 01/17/20 07:57 01/18/2014:00 MBP Mt.Juliet,TN
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Pilot Apex Environmental 768490-047 L1179579 01/21/20 09:51 3 of 10

CASE NARRATIVE ONE LAB.NATIONWIDE.
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All sample aliquots were received at the correct temperature,in the proper containers,with the
appropriate preservatives,and within method specified holding times,unless qualified or notated within 2
the report. Where applicable,all MDL(LOD)and RDL(LOQ)values reported for environmental samples Tc
have been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control
are within established criteria except where addressed in this case narrative,a non-conformance form 3
or properly qualified within the sample results.By my digital signature below,I affirm to the best of my Ss
knowledge,all problems/anomalies observed by the laboratory as having the potential to affect the
quality of the data have been identified by the laboratory,and no information or data have been
knowingly withheld that would affect the quality of the data.
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Project Manager cAl
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ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
Pilot Apex Environmental 768490-047 L1179579 01/21/20 09:51 4 of 10

OUTALL 001 SAMPLE RESULTS - 01 ONE LAB.NATIONWIDE. JO
Collected date/time: 01/14/20 11:20 L1179579
Additional Information
Result Units Cp
Analyte
2
pH(On Site) 6.86 su Tc
Temperature(on-site) 16.6 Deg C
Flow Measure 10 gpm s
Ss
Gravimetric Analysis by Method 2540 D-2011 4
Result Qualifier RDL Dilution Analysis Batch Cn
Analyte mg/I mg/I date/time
Suspended Solids 20.0 P1 5.00 1 01/16/2020 01:13 WG1411760 Sr
Wet Chemistry by Method 1664A `'Qc
Result Qualifier RDL Dilution Analysis Batch
Analyte mg/I mg/I date/time 7
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TPH-Oil&Grease ND 5.00 1 01/18/202014:00 WG1413195
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Pilot Apex Environmental 768490-047 L1179579 01/21/20 09:51 5 of 10

WG1411760 QUALITY CONTROL SUMMARY ONE LAB.NATIONWIDE.
Gravimetric Analysis by Method 2540 D-2011 L1179579-01
Method Blank (MB) r(MB)R3491287-1 01/16/20 01:13Cp
MB Result MB Qualifier MB MDL MB RDL
2
Analyte mg/I mg/I mg/I Tc
Suspended Solids U 0.350 2.50
3
Ss
L1179526-01 Original Sample (OS) • Duplicate (DUP) 4
(OS)L1179526-01 01/16/20 01:13•(DUP)R3491287-3 01/16/20 01:13 Cn
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits Sr
Analyte mg/I mg/I % %
Suspended Solids 115 130 1 12.2 J3 5 6
Qc
L1179579-01 Original Sample (OS) • Duplicate (DUP) 7GI
(OS)L1179579-01 01/16/20 01:13•(DUP)R3491287-4 01/16/20 01:13
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits Al
Analyte mg/I mg/I % %
Suspended Solids 20.0 23.0 1 14.0 P1 5 9
Sc
Laboratory Control Sample (LCS)
(LCS)R3491287-2 01/16/20 01:13
Spike Amount LCS Result LCS Rec. Rec.Limits LCS Qualifier
Analyte mg/I mg/I % %
Suspended Solids 773 816 106 85.0-115
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
Pilot Apex Environmental 768490-047 L1179579 01/21/20 09:51 6 of 10

WG1413195 QUALITY CONTROL SUMMARY ONE LAB.NATIONWIDE.
Wet Chemistry by Method 1664A L117 9 5 79-01
Method Blank (MB)
Cp
(MB)R3491931-1 01/18/20 14:00
MB Result MB Qualifier MB MDL MB RDL
Analyte mg/I mg/I mg/I Tc
TPH-Oil&Grease U 0.725 5.00
3
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Laboratory Control Sample (LCS) • Laboratory Control Sample Duplicate (LCSD)
4Cn
(LCS)R3491931-2 01/18/20 14:00•(LCSD)R3491931-3 01/18/20 14:00
Spike Amount LCS Result LCSD Result LCS Rec. LCSD Rec. Rec.Limits LCS Qualifier LCSD Qualifier RPD RPD Limits
s
Analyte mg/I mg/I mg/I % % % % % Sr
TPH-Oil&Grease 20.0 15.8 14.7 79.0 73.5 64.0-132 7.21 34
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Pilot Apex Environmental 768490-047 L1179579 01/21/20 09:51 7 of 10

GLOSSARY OF TERMS ONE LAB.NATIONWIDE. JO
Guide to Reading and Understanding Your Laboratory Report
The information below is designed to better explain the various terms used in your report of analytical results from the Laboratory. This is not Cp
intended as a comprehensive explanation,and if you have additional questions please contact your project representative.
2
Results Disclaimer-Information that may be provided by the customer,and contained within this report,include Permit Limits,Project Name, Tc
Sample ID,Sample Matrix,Sample Preservation,Field Blanks,Field Spikes,Field Duplicates,On-Site Data,Sampling Collection Dates/Times,and
Sampling Location.Results relate to the accuracy of this information provided,and as the samples are received.
3
Abbreviations and Definitions Ss
MDL Method Detection Limit.
4
ND Not detected at the Reporting Limit(or MDL where applicable). Cn
RDL Reported Detection Limit.
Rec. Recovery. 5
RPD Relative Percent Difference. Sr
SDG Sample Delivery Group.
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U Not detected at the Reporting Limit(or MDL where applicable). Qc
Analyte The name of the particular compound or analysis performed.Some Analyses and Methods will have multiple analytes
reported.
If the sample matrix contains an interfering material,the sample preparation volume or weight values differ from the GI
Dilution standard,or if concentrations of analytes in the sample are higher than the highest limit of concentration that the
laboratory can accurately report,the sample may be diluted for analysis.If a value different than 1 is used in this field,the
result reported has already been corrected for this factor. Al
These are the target%recovery ranges or%difference value that the laboratory has historically determined as normal
Limits for the method and analyte being reported.Successful QC Sample analysis will target all analytes recovered or
duplicated within these ranges. 9
The non-spiked sample in the prep batch used to determine the Relative Percent Difference(RPD)from a quality control SC
Original Sample sample.The Original Sample may not be included within the reported SDG.
This column provides a letter and/or number designation that corresponds to additional information concerning the result
Qualifier reported.If a Qualifier is present,a definition per Qualifier is provided within the Glossary and Definitions page and
potentially a discussion of possible implications of the Qualifier in the Case Narrative if applicable.
The actual analytical final result(corrected for any sample specific characteristics)reported for your sample.If there was
no measurable result returned for a specific analyte,the result in this column may state"ND"(Not Detected)or"BDL"
Result (Below Detectable Levels).The information in the results column should always be accompanied by either an MDL
(Method Detection Limit)or RDL(Reporting Detection Limit)that defines the lowest value that the laboratory could detect
or report for this analyte.
Uncertainty Confidence level of 2 sigma.
(Radiochemistry)
A brief discussion about the included sample results,including a discussion of any non-conformances to protocol
Case Narrative(Cn) observed either at sample receipt by the laboratory from the field or during the analytical process.If present,there will
be a section in the Case Narrative to discuss the meaning of any data qualifiers used in the report.
Quality Control This section of the report includes the results of the laboratory quality control analyses required by procedure or
Summary(Qc) analytical methods to assist in evaluating the validity of the results reported for your samples.These analyses are not
being performed on your samples typically,but on laboratory generated material.
This is the document created in the field when your samples were initially collected.This is used to verify the time and
Sample Chain of date of collection,the person collecting the samples,and the analyses that the laboratory is requested to perform.This
Custody(Sc) chain of custody also documents all persons(excluding commercial shippers)that have had control or possession of the
samples from the time of collection until delivery to the laboratory for analysis.
This section of your report will provide the results of all testing performed on your samples.These results are provided
Sample Results(Sr) by sample ID and are separated by the analyses performed on each sample.The header line of each analysis section for
each sample will provide the name and method number for the analysis reported.
Sample Summary(Ss) This section of the Analytical Report defines the specific analyses performed for each sample ID,including the dates and
times of preparation and/or analysis.
Qualifier Description
J3 The associated batch QC was outside the established quality control range for precision.
P1 RPD value not applicable for sample concentrations less than 5 times the reporting limit.
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
Pilot Apex Environmental 768490-047 L1179579 01/21/20 09:51 8 of 10

ACCREDITATIONS & LOCATIONS ONE LAB.NATIONWIDE. lik
Pace National is the only environmental laboratory accredited/certified to support your work nationwide from one location.One phone call,one point of contact,one laboratory.No other lab is as
accessible or prepared to handle your needs throughout the country.Our capacity and capability from our single location laboratory is comparable to the collective totals of the network 1
laboratories in our industry.The most significant benefit to our one location design is the design of our laboratory campus.The model is conducive to accelerated productivity,decreasing C p
turn-around time,and preventing cross contamination,thus protecting sample integrity.Our focus on premium quality and prompt service allows us to be YOUR LAB OF CHOICE.
•Not all certifications held by the laboratory are applicable to the results reported in the attached report.
•Accreditation is only applicable to the test methods specified on each scope of accreditation held by Pace National. 2
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State Accreditations
Alabama 40660 Nebraska NE-OS-15-053
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Alaska 17-026 Nevada TN-03-2002-34
Arizona AZ0612 New Hampshire 2975 4
Arkansas 88-0469 New Jersey—NELAP TN002 Cn
California 2932 New Mexico' n/a
Colorado TN00003 New York 11742
Connecticut PH-0197 North Carolina Env375 Sr
Florida E87487 North Carolina' DW21704
Georgia NELAP North Carolina' 41
Georgia' 923 North Dakota R-140 Qc
Idaho TN00003 Ohio—VAP CL0069
Illinois 200008 Oklahoma 9915
Indiana C-TN-01 Oregon TN200002 GI
Iowa 364 Pennsylvania 68-02979
Kansas E-10277 Rhode Island LA000356
Kentucky'` 90010 South Carolina 84004 Al
Kentucky' 16 South Dakota n/a
Louisiana A130792 Tennessee" 2006
Louisiana' LA180010 Texas T1047 04 24 5-18-15 SC
Maine TN0002 Texas 5 LAB0152
Maryland 324 Utah TN00003
Massachusetts M-TN003 Vermont VT2006
Michigan 9958 Virginia 460132
Minnesota 047-999-395 Washington C847
Mississippi TN00003 West Virginia 233
Missouri 340 Wisconsin 9980939910
Montana CERT0086 Wyoming A2LA
Third Party Federal Accreditations
A2LA—ISO 17025 1461.01 AIHA-LAP,LLC EMLAP 100789
A2LA—ISO 17025 5 1461.02 DOD 1461.01
Canada 1461.01 USDA P330-15-00234
EPA—Crypto TN00003
'Drinking Water z Underground Storage Tanks 'Aquatic Toxicity 'Chemical/Microbiological 5 Mold `Wastewater n/a Accreditation not applicable
Our Locations
Pace National has sixty-four client support centers that provide sample pickup and/or the delivery of sampling supplies.If you would like assistance from one of our support offices,please contact
our main office.Pace National performs all testing at our central laboratory.
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ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
Pilot Apex Environmental 768490-047 L1179579 01/21/20 09:51 9 of 10

Billing Information: Analysis',Container/Pr servative 'Chain of Custody Page l of•i
Pilot Apex Environmental Accounts Payable/Gary Douglas Prers
5508 Lonas Road k 7.2ce Analytical'
$.a C w C v,rn r.Tv.s a„n••rwr,+
7724 Garland Circle Knoxville,TN 37993
Roanoke,VA 24019
Report to• Email To rwagner Oapexcos.corn 12065 Lebanon ad OV . Q
Mount Whet,TN 77122
Robert Wagner Phone 615-75e 5e58
City/State Q�tA.S lea/r s1%s Cir
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Description: Pilot 58 Collected: 0C PT MT CT
Table
Phone [phone] Client Project# Lab Projects SDG a !(1 q�'i
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Collected by(signature): Rush? (Lab MUST Be Notified) Quote M P p
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- -- , -_Same Day Five Day er ly
_Next Day _5 Day(Rad Only) Date Results Needed W . PM:633•Pam Langford
Immediately .� _ _Two Day _10 Day(Rad On'y) No. _ = PB:la_a1 —f 1 45
Packed on Ice N_ Y _Three Day of
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Shipped Via:FedEX Ground
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Sample ID Comp/Grab Matrix' Depth 1 Date Time Ia. M Remarks 1 Sample—1
oVrFAU.. t Cif0 n GW \e tis-k•20 \t .0 2 X X 61
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'Matrix: Remarks: Sample Receipt Checklist
pH Ga.% Temp Its.(.a COC Seal Present/Intact: _HP ear N
SS•Soil AIR-Air F-filter
COC Signed/Accurate:
GW-Groundwater B-Bioassay _N
Flow °/39te'bther Bottles arrive intact:
WW-Waste Water Correct bottles used: Si _—NN
DW-Drinking Water .f Sufricient volume sent: ✓1' _N
Samples reyarned via: Tracking 0 13$Z, y�\‘ 4 k/ Tat If Applicable
OT-Ocher UPS Feax _CourierP
ace: Y N
e� — VOA Zero HeadsPreservation Correct/Checked: N
Rejioquichod :(Signature) Date: Time: Received by.(Signatcre) Trip Blank Received: Yes/ PAD Screen <0.5 xR/hr: —y N
MCI./MeoN
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Relmquishe (Signature) Temp: Bott
Date Time: Received by(Signature) er !lades Received. If preservation required by Login:Date/Time
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Relinquished by:(Signature) Date Time Recei f lab by:(Signature) Date:( Time:: Hold: Conditi%
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