NCG030056_Monitoring Report_22122020

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NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG031 0 10 15 16
Facility Name: Gilbarco inc
Person Collecting Samples: John Burke
Laboratory Name: Pace
Facility County: Guilford 0 1 Laboratory Cert. No.: 12, 40, 633
Discharge during this period: ❑■ Yes ❑ No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances? ❑■ Yes ❑ No
If so, which Tier (I, II, or III)? 1 D
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
Outfall)01
Outfall02
Outfall03
Outfall
Outfall
Code
N/A
Receiving Stream Class
5
5
5
N/A
Date Sample Collected MM/DD/YYYY
11/26/2020
11/26/2020
01/26/2020
46529
24-Hour Rainfall in inches
0.3
0.3
0.3
005S2
Non -Polar Oil & Grease in mg/L (15)
<5.00
<5.00
<5.00
C0530
TSS in mg/L (100 or 50*)
136
8.4
17.7
00400
pH in standard units (6.0-9.0)
7.33
6.20
5.84
NCOIL
New Motor/Hydraulic Oil Usage in
gal/month
01119
Copper, total recoverable in mg/L
0.013
0.006
0.012
(0.010 FW, 0.005 SW)
01051
Lead, total recoverable in mg/L
0.005
<0.005
<0.005
(0.075 FW, 0.220 SW)
01094
Zinc, total recoverable in mg/ L (0.126
0.077
0.075
0.120
FW, 0.095 SW)
78141
Total Toxic Organics (TTO) in mg/L(1)
SMP
SMP
SMP
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L.
Notes (optional):
"I certify by my signature below, 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 or Delegated Authorized Individual
Date

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aceAnalytical
www.pacelabs.com
December 08, 2020
John Burke
Gilbarco
7300 West Friendly Ave.
Greensboro, NC 27410
RE: Project: Stormwater Sampler
Pace Project No.: 92508405
Dear John Burke:
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Enclosed are the analytical results for sample(s) received by the laboratory on November 30, 2020. The results relate only
to the samples included in this report. Results reported herein conform to the applicable TNI/NELAC Standards and the
laboratory's Quality Manual, where applicable, unless otherwise noted in the body of the report.
The test results provided in this final report were generated by each of the following laboratories within the Pace Network:
• Pace Analytical Services -Asheville
• Pace Analytical Services - Charlotte
• Pace Analytical Services - Eden
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
AMw_y4�
Stephanie Knott
[e-mail]
336-996-2841
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 13

IaceAnalytical
www.pacelabs.com
Project: Stormwater Sampler
Pace Project No.: 92508405
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Pace Analytical Services Charlotte
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
Louisiana/NELAP Certification # LA170028
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
North Carolina Drinking Water Certification #: 37712
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Drinking Water Certification #: 37738
CERTIFICATIONS
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Virginia/VELAP Certification #: 460221
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 633
Virginia/VELAP Certification #: 460025
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 2 of 13

aceAnalytical
www.pacelabs.com
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
SAMPLE SUMMARY
Project: Stormwater Sampler
Pace Project No.: 92508405
Lab ID
Sample ID
Matrix
Date Collected
Date Received
92508405001
001 Outlet
Water
11/26/20 06:10
11/30/20 11:18
92508405002
002 Outlet
Water
11/26/20 06:00
11/30/20 11:18
92508405003
003 Outlet
Water
11/26/20 05:50
11/30/20 11:18
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 3 of 13

aceAnalytical
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Project: Stormwater Sampler
Pace Project No.: 92508405
Lab ID Sample ID
92508405001 001 Outlet
92508405002 002 Outlet
92508405003 003 Outlet
PASI-A = Pace Analytical Services - Asheville
PASI-C = Pace Analytical Services - Charlotte
PASI-E = Pace Analytical Services - Eden
SAMPLE ANALYTE COUNT
Method
SM 2540D-2011
EPA 1664B
EPA 200.7 Rev 4.4 1994
SM 2540D-2011
EPA 1664B
EPA 200.7 Rev 4.4 1994
SM 2540D-2011
EPA 1664B
EPA 200.7 Rev 4.4 1994
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Analytes
Analysts
Reported
MLS1
1
CJM
1
IDS
3
MLS1
1
CJM
1
IDS
3
MLS1
1
CJM
1
DS
3
Page 4 of 13

acice Analyfical
www.pacelabs.com
ANALYTICAL RESULTS
Project: Stormwater Sampler
Pace Project No.: 92508405
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Sample: 001 Outlet
Parameters
Lab ID: 92508405001 Collected: 11/26/20 06:10
Results Units Report Limit DF
Received: 11/30/20 11:18 Matrix: Water
Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Eden
Total Suspended Solids
136 mg/L
5.3
1
12/01/20 08:27
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Pace Analytical Services - Charlotte
Total Petroleum Hydrocarbons
ND mg/L
5.0
1
12/08/20 08:35
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4.4
1994 Preparation
Method: EPA 200.7 Rev 4.4 1994
Pace Analytical Services -Asheville
Copper
0.013 mg/L
0,0050
1
12/05/20 01:37 12/06/20 17:18 7440-50-8
Lead
0.0050 mg/L
0.0050
1
12/05/20 01:37 12/06/20 17:18 7439-92-1
Zinc
0.077 mg/L
0.010
1
12/05/20 01:37 12/06/20 17:18 7440-66-6
Date: 12/08/2020 03:41 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 5 of 13

aceAnalytical
www.pacelabs.com
ANALYTICAL RESULTS
Project: Stormwater Sampler
Pace Project No.: 92508405
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Sample: 002 Outlet Lab ID: 92508405002 Collected: 11/26/20 06:00 Received: 11/30/20 11:18 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Eden
Total Suspended Solids
8.4 mg/L
3.2
1
12/01/20 08:27
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Pace Analytical Services - Charlotte
Total Petroleum Hydrocarbons
ND mg/L
5.0
1
12/08/20 08:35
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation
Method: EPA 200.7 Rev 4.4 1994
Pace Analytical Services -Asheville
Copper
0.0058 mg/L
0.0050
1
12/05/20 01:37 12/06/20 17:21 7440-50-8
Lead
ND mg/L
0.0050
1
12/05/20 01:37 12/06/20 17:21 7439-92-1
Zinc
0.075 mg/L
0.010
1
12/05/20 01:37 12/06/20 17:21 7440-66-6
Date: 12/08/2020 03:41 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 6 of 13

aceAnalytical
www.pacelabs.com
ANALYTICAL RESULTS
Project: Stormwater Sampler
Pace Project No.: 92508405
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Sample: 003 Outlet Lab ID: 92508405003 Collected: 11/26/20 05:50 Received: 11/30/20 11:18 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids
Analytical Method: SM 2540D-2011
Pace Analytical Services - Eden
Total Suspended Solids
17.7 mg/L
3.4
1
12/01/20 08:27
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Pace Analytical Services - Charlotte
Total Petroleum Hydrocarbons
ND mg/L
5.0
1
12/08/20 08:35
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4.4 1994 Preparation
Method: EPA 200.7 Rev 4.4 1994
Pace Analytical Services -Asheville
Copper
0.012 mg/L
0.0050
1
12/05/20 01:37 12/06/20 17:37 7440-50-8
Lead
ND mg/L
0.0050
1
12/05/20 01:37 12/06/20 17:37 7439-92-1
Zinc
0.12 mg/L
0.010
1
12/05/20 01:37 12/06/20 17:37 7440-66-6
Date: 12/08/2020 03:41 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 7 of 13

aceAnalytical
www.pacelabs.com
QUALITY CONTROL DATA
Project: Stormwater Sampler
Pace Project No.: 92508405
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
QC Batch: 583485
Analysis Method:
SM 2540D-2011
QC Batch Method: SM 2540D-2011
Analysis Description:
2540D Total Suspended Solids
Laboratory:
Pace Analytical Services - Eden
Associated Lab Samples: 92508405001, 92508405002, 92508405003
METHOD BLANK: 3084976
Matrix: Water
Associated Lab Samples: 92508405001, 92508405002, 92508405003
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Total Suspended Solids
mg/L
ND
2.5 12/01/20 08:26
LABORATORY CONTROL SAMPLE:
3084977
Spike LCS
LCS % Rec
Parameter
Units
Conc. Result
% Rec Limits Qualifiers
Total Suspended Solids
mg/L
250 242
97 90-110
SAMPLE DUPLICATE: 3085030
92508454001 Dup
Max
Parameter
Units
Result Result
RPD RPD Qualifiers
Total Suspended Solids
mg/L
381
411 8 25
SAMPLE DUPLICATE: 3085031
92508461001 Dup
Max
Parameter
Units
Result Result
RPD RPD Qualifiers
Total Suspended Solids
mg/L
405
370 9 25
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/08/2020 03:41 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 13

aceAnalytical
www.pacelabs.com
QUALITY CONTROL DATA
Project: Stormwater Sampler
Pace Project No.: 92508405
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
QC Batch: 585226 Analysis Method:
QC Batch Method: EPA 1664B Analysis Description:
Laboratory:
Associated Lab Samples: 92508405001, 92508405002, 92508405003
EPA 1664B
1664 SGT-HEM, TPH
Pace Analytical Services - Charlotte
LABORATORY CONTROL SAMPLE:
3093376
Spike LCS
LCS % Rec
Parameter
Units
Conc. Result
% Rec Limits Qualifiers
Total Petroleum Hydrocarbons
mg/L
20 13.5
68 64-132
MATRIX SPIKE SAMPLE:
3093377
92509161001 Spike
MS MS % Rec
Parameter
Units
Result Conc.
Result % Rec Limits Qualifiers
Total Petroleum Hydrocarbons
mg/L
ND 20
ND 2 64-132 M1
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/08/2020 03:41 PM without the written consent of Pace Analytical Services, LLC.
Page 9 of 13

aceAnalytical
www.pacelabs.com
QUALITY CONTROL DATA
Project: Stormwater Sampler
Pace Project No.: 92508405
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
QC Batch: 584771
Analysis Method:
EPA 200.7 Rev 4.4 1994
QC Batch Method: EPA 200.7 Rev 4.4 1994
Analysis Description:
200.7 MET
Laboratory:
Pace Analytical Services - Asheville
Associated Lab Samples: 92508405001, 92508405002, 92508405003
METHOD BLANK: 3091372
Matrix: Water
Associated Lab Samples: 92508405001, 92508405002, 92508405003
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Copper
mg/L
ND 0.0050 12/06/2016:35
Lead
mg/L
ND 0.0050 12/06/2016:35
Zinc
mg/L
ND 0.010
12/06/2016:35
LABORATORY CONTROL SAMPLE:
3091373
Spike LCS
LCS % Rec
Parameter
Units
Conc. Result
% Rec Limits Qualifiers
Copper
mg/L
0.25 0.26
103 85-115
Lead
mg/L
0.25 0.25
101 85-115
Zinc
mg/L
0.25 0.25
98 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 3091374
3091375
MS MSD
92507513001
Spike Spike MS
MSD MS MSD
% Rec Max
Parameter Units
Result
Conc. Conc. Result
Result % Rec % Rec
Limits RPD RPD Qual
Copper mg/L
212 ug/L
0.25 0.25 0.48
0.48 109 109
70-130 0 20
Lead mg/L
ND
0.25 0.25 0.26
0.26 104 104
70-130 0 20
Zinc mg/L
61.0 ug/L
0.25 0.25 0.33
0.33 109 108
70-130 1 20
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 3091376
MS
92508491001
Spike
Parameter Units
Result
Conc.
Copper mg/L
0.014
0.25
Lead mg/L
0.0052
0.25
Zinc mg/L
0.038
0.25
3091377
MSD
Spike
MS
MSD
MS
MSD
% Rec
Max
Conc.
Result
Result
% Rec
% Rec
Limits
RPD RPD Qual
0.25
0.29
0.28
109
108
70-130
1 20
0.25
0.27
0.27
105
105
70-130
0 20
0.25
0.31
0.31
107
107
70-130
0 20
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/08/2020 03:41 PM without the written consent of Pace Analytical Services, LLC.
Page 10 of 13

aceAnalytical
www.pacclabs.com
QUALIFIERS
Project: Stormwater Sampler
Pace Project No.: 92508405
DEFINITIONS
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
TNTC - Too Numerous To Count
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
PQL - Practical Quantitation Limit.
RL - Reporting Limit - The lowest concentration value that meets project requirements for quantitative data with known precision and
bias for a specific analyte in a specific matrix.
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI - The NELAC Institute.
ANALYTE QUALIFIERS
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/08/2020 03:41 PM without the written consent of Pace Analytical Services, LLC. Page 11 of 13

aceAnalytical
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QUALITY CONTROL DATA CROSS REFERENCE TABLE
Pace Analytical Services, LLC
106 Short St.
Kernersville, NC 27284
336-996-2841
Project:
Pace Project No.:
Stormwater Sampler
92508405
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch
Analytical Method
Batch
92508405001
001 Outlet
SM 2540D-2011
583485
92508405002
002 Outlet
SM 2540D-2011
583485
92508405003
003 Outlet
SM 2540D-2011
583485
92508405001
001 Outlet
EPA 1664B
585226
92508405002
002 Outlet
EPA 1664B
585226
92508405003
003 Outlet
EPA 1664B
585226
92508405001
001 Outlet
EPA 200.7 Rev 4.4 1994
584771
EPA 200.7 Rev 4.4 1994
584807
92508405002
002 Outlet
EPA 200.7 Rev 4.4 1994
584771
EPA 200.7 Rev 4.4 1994
584807
92508405003
003 Outlet
EPA 200.7 Rev 4.4 1994
584771
EPA 200.7 Rev 4.4 1994
584807
Date: 12/08/2020 03:41 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 12 of 13

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Page 13 of 13

GVR-226
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https:Hdeq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/C/ / / / / / / / or Certificate of Coverage No.: N/C/G/ a/3/ Lx t) / S--/ 6/
Facility Name: t
County: c Coun �u ; � ��� � Phone No.
Inspector: �'� i 4�
Date of Inspection: k L
Time of Inspection:
Total Event Precipitation (inches):
0,30
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:
of Permittee or Designee)
1. Outfall Description:
Outfall No. 0 b Structure (pipe, ditch, etc.): D A--Z�4-
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): �j o,^/f
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
�v.
1 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:
1 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:
7.
8.
9.
10.
1 2 3°` 4 5
Is there any foam in the stormwater discharge? o Yes No.
Is there an oil sheen in the stormwater discharge? 0Yes No.
Is there evidence of erosion or deposition at the outfall? Yes O No.
Other Obvious Indicators of Stormwater Pollution:
List and describe
► �/i- (-,) .1-1 c i-�-
U. '&o
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 06/01/2018

GVR-226
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc.gov/about/divisions/enel-gy-mineral-land-resources/
np des-storinwater-gp s
Permit No.: N/C/ or Certificate of Coverage No.: N/C/G/ 6131
Facility Name:
3
County: Gv L Phone No. 3 3 L S"Lj 7— S�'O a o
Inspector: 07, VKJ
Date of Inspection:
Time of Inspection: (3
Total Event Precipitation (inches):
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 tkjs signatu ce�t� y-that4hi&iz is accurate and complete to the best of my knowledge:
(Signatilre of Permittee or Designee)
1. Outfall Description:
Outfall No. 0 0 '�— Structure (pipe, ditch, etc.): kl�
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
�,� I—iy 14-Jy�-� S i 1�► L t�; S , LVfi-
Page 1 of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L-T
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): �✓`��--
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 / 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:
;D
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:
j 1 2 3 4 5
7. Is there any foam in the stormwater discharge? o Yes No.
S. Is there an oil sheen in the stormwater discharge? OYes No.
9. Is there evidence of erosion or deposition at the outfall? U Yes XNo.
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 06/01/2018

. GVR-226
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https:Hdeq.ne.gov/about/divisions/enel-gy-mineral-land-resources/
np des-stormwater-gp s
Permit No.: N/C/ or Certificate of Coverage No.: N/C/G/ 61 / 6/ 6 / 6 / 6/
Facility Name:
County: Phone No.
Inspector: �i tfZ
Date of Inspection:
Time of Inspection: Fs L)
Total Event Precipitation (inches): 0-,,3 0
All permits require qualitative monitoring to be perfonned 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.
............................................ _............................................................................................................................................. I ....................................... _...
By this Signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
1. 'Outfall Description:
Outfall No. 0 0 . Structure (pipe, ditch, etc.): � � G-��—
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
-TA,*C AL— 9AA1 C, %
Page 1 of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Li-16vr
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): N��z-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
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 1 is no solids and 5 is extremely muddy:
2 3 4 5
7.
8.
9.
Is there any foam in the stormwater discharge? O Yes No.
a
Is there an oil sheen in the stormwater discharge? QYes No.
Is there evidence of erosion or deposition at the outfall? o Yes A
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 06/01/2018

GVR-226
N---.
Enidr-ommenta!
Quality.
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.ne.gov/about/divisions/energy-mineral-land-resources/
np des-storinwater-gp s
Permit No.: N/C/ or Certificate of Coverage No.: N/C/G/ (3/3/ L�/ t� / 657% b/
Facility Name: r lbe-cam; <—
County: U Phone No. 3 3 L �cl 7 S-0 i;
Inspector: 07,
Date of Inspection:
Time of Inspection: `.
Total Event Precipitation (inches):
0-10
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 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 sig-lature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Vermittee or Designee)
1. Out 11 Description:
Outfall No. 0 , Structure (pipe, ditch, etc.):
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:��
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): N v,Ni�'w=
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 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 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 1 is no solids and 5 is extremely muddy:
LI) 2 3 4 5
7.
8.
9.
10.
Is there any foam in the stormwater discharge? o Yes
Is there an oil sheen in the stormwater discharge? oYes
Is there evidence of erosion or deposition at the outfall? o Yes
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 06/01/2018

GVR-226
fntlironmental
Quality.
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https:Hdeq.ne.gov/about/divisions/energy-mineral-land-resources/
npdes -stortnwater-gps
Permit No.: N/C/ / / / / / / / or Certificate of Coverage No.: N/C/G/ 613 / of C5 / S / 6/
Facility Name: G r \ bc,, -Cz
3
County: Gu m Phone No. 3 3 LS"I 7 !� b 6 0
Inspector: VVj �.61 !& i (p`
Date of Inspection: t k
Time of Inspection:,
Total Event Precipitation (inches): 0ti,3 D
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 thisAgaatur-@,—I-ee4i-fy-thaLthilreSort is accurate and complete to the best of my knowledge:
Permittee or Designee)
1. Outfall Description:
Outfall No. 00 Structure (pipe, ditch, etc.): P-Z-Vr- k, k--
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C-1.-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy: �-
6 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:
d/.,.
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:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? 0 Yes
S. Is there an oil sheen in the stormwater discharge? QYes
No.
No.
9. Is there evidence of erosion or deposition at the outfall? U 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 06/01/2018

GVR-226
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https:Hdeq.ne.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/C/ / / / / / / / or Certificate of Coverage No.: N/C/G/ 6/3/ 6/.45 / c- / b/
Facility Name: ic.,r-
County: Phone No. 3 3 L ' S-cj % SA) i,' o
Inspector: wo &�Aljtip.
Date of Inspection: E � 1. � L I
Time of Inspection: 6 r -3 Z)
Total Event Precipitation (inches):
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:
of Permittee or Designee
1.'—'Outfall Description:
Outfall No. 0 0 -( Structure (pipe, ditch, etc.):
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
SWU-242, Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 (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 02' 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:
1 (2) 3 4 5
7.
8.
9.
Is there any foam in the stormwater discharge? O Yes No.
Is there an oil sheen in the stormwater discharge? QYes No.
Is there evidence of erosion or deposition at the outfall? Q 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 06/01/2018