NCS000325_MONITORING INFO_20181114

STORMWATER-DIVISION-CODING-SHEET-
PERMIT NO.
ns � 5.0 caos S
DOC TYPE
❑ FINAL PERMIT
,MONITORING INFO
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑
YYYYM M DD

FEHR GRL:",'�M
ENGINEERING & ENVIRONMENTAL
RECEIVED
UPS Next Day Air Tracking No. 1Z 651 395 01 5523 1164
NOV 14 2018
November 13, 2018 CENTRAL FILES
DWRSECTION k�'�
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Storm Water Discharge Outfall (SDO) Monitoring Report - October 2018
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for October 2018.
® Please note the following
• Storm water samples were collected during a representative storm event on
a
October 11, 2018.
v
The results for zinc are above the facility's permit benchmark for both
Outfall 001 N and Outfall 002 S.
• The facility has already implemented its Tier 2 response and will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact'
this office.
Sincerely,
A"T.�U-k-)
LTrirnW, CHMM
Environmental Scientist
ALT:dtd
Enclosures
cc: Marto Carter, Patch Rubber Company (with Enclosures)
0:\Patch Rubber Company\18-105\PA Final\18-105 -Div of Water Quality - 2018-11-13 -Storm Water SDO October 2018.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

I
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber Company
PERSON CO L LECTING SAM PLE(S) Marjo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
(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 Halifax
PHONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Total
Flow (if app.)
1 Total
Rainfall
----------
----------
----------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfdl
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-IIEM), if
appl.
Total
Suspended
Solids
pit
New Motor
Oil Usage
mo/dd/ yr
MG
inches
m I
mg/1
unit
'al/mo
Form S W U-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 10/11/2018
Total Event Precipitation (inches): 0.44
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — sec 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 mane the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my know and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the s ' ty of fines and imprisonment for knowing violations.'
0111Z P,
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
Ar Laboratory Certification No.165
Contact: Amy Trimble
Report Date:
11/8/2018
Client: Fehr Graham
NPDES#:
NCS000325
221 E Main St
Project:
Patch Rubber Co.
Freeport, IL 61032
Date Sample Rcvd:
10/18/2018
Meritech Work Order #
101818100 Sample:
OF 001 N Grab
10/11/18
Parameters
Results
Analysis Date
Reporting Limit
od
Method
COD
50 mg/L
10/20/18
15 mg/L
EPA 410.4
Zinc, total
0.814 mg/L
11/7/18
0.010 mg/L
EPA 200.8
Meritech Work Order #
IOIB18101 Sample:
OF 002 S Grab
10/11/18
Parameters
Results
Analysis Date
Reporting Litni
Method .
COD
25 mg/L
10/20/18
15 mg/L
EPA 410.4
Zinc, total
0.295 mg/L
11/7/18
0.010 mg/L
EPA 200.8
I hereby certify that/ have reviewed and approve these data.
Laboratory Representative
642 Tamco Road, Reidsville -,North Carolina 27320
tel.[phone] fax.[phone]

Chain of Custody Record (COC)
NPDES#:1J�S
Client: Fehr Trw-nry) Phone: [phone](a43
Address:__Ml E. rpour-) Fax: 81 a35-4Ep2"a
�rrr -n to103� ocfr:mvfc. Achr- ratvm.cam
Email: mcarfer@paieh yr to n
plec-; ICjj ProjeCt:PCf'G/'1 Pi ihhw_,('(� r
P.O.#:
Attention:&M=_TvnmTurn Around Time";
How would you like your report sent? 'RUSH work needs prior approval.
Circle all that a I Email referred), Fax, Mail 5td lOdS s) 3-s Days Z�s
apply: �'�
Person Taking Sample (Sign/Print):
Lab Use Only
Sample Location
F 00 1
MERITECH, INC.
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritechlabs.com
Sampling Dates&Times
and/or ID d Start End
Date Time Date Time
l49'l/-r8 3:1o/44+ /o-if-if 3!fzpr
Comp?
Grab?
(T
#of
Cont.
Test(s)
Required
lUU
On
es N
/ No
Ci00
CI OK?
00
OF oo
/0-1148
i:n PM
o_ Y ry
;.r3aM
&
a
0l
=
Temperature upon
Method of
Shipment:
••" Dethlorination <0.5 m) of Ammonia Cyanide, Phenol
Comments:
Are these results for regulatory purposes? Yes ®
Relinquished by Time:
Date:
Relinqu" ed by: /�_/ D�t; Ti40
me
f r
Relinquish y: Date: Time:
and TKN samples must be done in the field rior.topresentation.••* Receipt:
1�'r-'
Compositor#
Jug #
No ❑ Report results in: mg/L mg/kg ❑
. Dg/L ❑
Received b _Inn
Receive di Date: Time:
- Receiv Y b' Tim
❑ UPS
❑ Fed Ex
❑Hand Delivery
® Other
(l �

r:.
HC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidonceonfillingoutthisform,pleasevisit-httt_///portalricdenrorg/w�ellwg/wg/ttr/npdesswiftatr4
Permit No.: )`I/L/g/­a/3/SQ/3/2/­a/ or Certificate of Coverage No.: jg/L/f1/—/_/_./_/_/_/
Facility Name: Patch Rubber ComDany
County:, Halifax Phone No. 252-536_2574
Inspector:
Date of Inspection:
Time of Inspection: / Total Event Precipitation (inches): �� / Ff' ` � 6
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
0 Yes ❑ No
Please -verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DW(
Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
or Designee)
Page 1 of 2
SWU-242, Last modified 10/2S//2012

,A- --
- 3v --- Outfail Description:--
OutfallNo..001 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North parking lot, roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C-le VA No
3. Odor. Describe any
weak chlorine odor, etc.): _
that the discharge may have (i.e., smells strongly of oil,
4. Clarity: Chnnse the. mimher which hest describes the clarity of the. discharge, where. 1 is
clear and 5 Is very cloudy: CV
2 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:
0 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:
11
601 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
a. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
9
61
Yes
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.
SWU-242, Lastmodified 10/2S/2012
Page 2 of 2

NC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform, please visit: Httn://portalncden-rorg/we /wa/ws/su/npdessw#cab-h
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company _
County: Halifax Phone No. 252-536-2574
Inspector: A51-ACut Q-s>rr`v,
Date of Inspection: It 1
Time of Inspection: S- (
Total Event Precipitation (inches):,
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 anoroval from the local DWQ Resional Office.
By this signature ], certify that this report is accurate and complete to the best of my knowledge:
or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description: j
OutfallNo. 002 Structure (pipe, ditch, etc.) Concrete pipe
i
Receiving Stream: —Unnamed tributary to Roanoke River
i
Describe the industrial activities that occur within the outfall drainage area: ;
Roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: N i A S
3. Odor:_Describe,ady_disiinctodors-thattlie.discharge_may-have(i.e-smells trongly_ofoil' __,
weak chlorine odor, etc.): t A 1 A
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy-
® 2 3 4 5
S. 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. Is there any foam in the stormwater discharge?
Yes
i5
8. Is there an oil sheen in the stormwater discharge?
Yes
ED
9. Is there evidence of erosion or deposition at the outf ill? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe N i A
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 10/25/2012

cn
FEHRGRA" CHI
ENGINEERING & ENVIRONMENTAL
UPS Overnight Tracking No.: 1Z 651 395 01 5754 8613
August 13, 2018
Division of Water Quality
Attention: Central Files .
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
AUG 16 2018
CENTRAL FILES
OWR SECTION
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - July 2018
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for July 2018.
Please note the following:
• Storm water samples were collected during a representative storm event on
July 6, 2018.
• The results for zinc are above the facility's permit benchmark for Outfall 001 N.
• The facility has already implemented its Tier 2 response and will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
a'Yn-Lj-} 1A�Lfmu-k-)
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosures
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\18-105\13A Final\18-105 - Storm Water SDO July 2018.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Marjo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
(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 Halifax
PHONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Pan B)
Part B: Vehicle Maintenance ActivitV Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-IIEM), if
appl.
Total
Suspended
Solids
PH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m I
m g/I
unit
gaUnio
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CIIARACI"EI2iS'r1CS:
11a1c 07/6/7018
Total Emu 1'recipihdion (inches): 1.1
Evem Duration (hours): (only irapplicable- see permit.)
(if more flan one storm event was smnpled)
Date
Total Event Precipitation (inches):
Event Donation (hours): __ (only if applicabir,- see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central riles
1617 Mail Service Center
Raleigh, North Carolina 27699.1617
"I certify, under penalty of law, that this document anti all imuchments were prepared wonder 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 I 'vskml, or those persons directly responsible for gathering the Information, the, information submitted is, to the
best of my knm vied brlie(, true, accurate, and complete. I am aware thatthere are significant penalties far submitting false information,
incinding the pasytlil' of Dues and imprisonntent for knowing violations."
(S
IF
(Da(e) If
Form S)W-247, last revised 21212012
]'age 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Brian Paluzzi
Client: Fehr Graham
220 Prairie St, Suite 208
Rockford, IL 61107
Report Date:
7/19/2018
NPDES #:
NCS000325
Project:
Patch Rubber Co.
Date Sample Rcvd:
7/10/2018
Meritech Work Order #
071018128 Sample:
OF 001 N Grab
7/6/18
Parameters
Results
Analysis Date Reporting Limit
Method
COD
22 mg/L
7/10/18 15 mg/L
EPA410.4
Zinc, total
0.460 mg/L •
7/13/18 0.010 mg/L
EPA 200.8
Meritech Work Order#
071018129 Sample:
OF 002 S Grab
7/6/18
Parameters
Results
Analysis Date Reporting Limit
Method
COD
27 mg/L
7/10/18 15 mg/L
EPA410.4
Zinc, total
0.042 mg/L
7/13/18 0.010 mg/L
EPA 200.8
I hereby certify that I have reviewed and approve these data.
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

5920LE Chain of Custody Record (COC)
NPDES#: A(( .,) 00b3a5
Client: I eh( (TrC_h- Phone: (SI5) a35-I 3
Address:a3l E. moan -it, Fax: (815) a35-403a
0.+r';mble0fchr-,qn7m r4rn. corn
1=YPtpo±i T7 - (nIU--�a Email: rnwrlh-rd p&tLrcYbbcr. rnrn
_Dgcxc t-'• Project:patrh RUbbfr(1Q0DXr)y
P.O.#: 7—
Attention: Arn_Fy*nbIc)Turn Around Time -
How would you like your report sent? `RUSH work needs prior approval.
Circle all that apply Email referred), Fax, Mail Ste! 10days) 3__5_oays 1a�asuJ9
��
� /p E � ITE C A � � � •
�b6 fG ry�
j
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
ti
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritechlabs.com
Sample Location and/or ID #
Sampling Dates &Times
p g
Person Taking Sample(Sign/Print):
Lab Use Only
Start
End
Comp?
Grab?
ttof
Cont.
Test(s) Required
On Ice?
Yes / No
pH OK?
Cl OK?
Date
Time
Date
Time
r-noi V
OF OO
l� l )8
3' 3�
�1�1(8
a'
Gr
a
1
'y
Temperature Upon
Receipt:
Method of
"' Dechlorination (<0.5 m) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field rionto preservation. '•'
J..t..
Shipment:
Comments:
Compositor #
❑ UPS
[Jug #
❑ Fed Ex
❑ Hand Delivery
® Other
Are these results for regulatory purposes? Yes X No ❑
Relinquished by: a Date: Time:
n �ZC v ((; Clp,�,
Relinquishe y: /g/ate; Time:
rF�
Report results In: mg/L _ mg/kg ❑ ug/L ❑
Received by: ate: Time:
C7 -L
Received by: Date: Time:
i
Relinquished by: Date: Time:
Receive
/
ate l'j Tint I t J

r
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguldanceonfillingout thisform,please visit: h[tn�//oortal.ncdemtorgiiv Liiwu7 .1isu/np&ssw#tab--
Permit No.: @i/f/�/ Q /SL/4/3/2 / 5/ or Certificate of Coverage No.:
Facility Name:
County:, - Hal
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): I
52-536-2574
1 q : (b,5
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
i Yes ❑ No
Please -verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event' (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 I)WQ Regional Office.
By this signature, 1 certify, that this report is accurate and complete to the best of my knowledge:
of IjVrniittee or Designee)
Pagel of 2
sWU-242, Last modified 10/25/2012

- --- — - 1: - - Outfall Description:._.._.. _ -.-- -_- ___.__..._ �._. __ . •_
Outfall No. 001 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River — _
Describe the industrial activities that occur within the outfall drainage area:
North parking lot roof drains
2. Color: Describe the color of the.discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:--,61tc4!R
3. Odor: Describe any di' unct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): No.Ur
4. Clarity: Choose the number which hest descrihes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: 10
2 3 4 5
S. 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 1 is no solids and 5 is extremely muddy:
b 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes Qo
9. Is there evidence of erosion or deposition at the outfall? Yes 65
10. Other Obvious Indicators of Stormwater Pollution:
List and
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 10/25/2012

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit:6itG�'//riort3l'ncdenr'iirg/w-/wq%wS%sit%o'-cps
Permit No.: j4/�/s /11/�/�/3 /2/ 5/ or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax_ Phone No. 252-536-2574—T_== __-
Inspector: c
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): /• / P � ' (", . 5
Was this a "Representative Storm Event' or "Measureable Storm Event" as defined by the permit?
(See information below.)
U9 Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
(, Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
} some permits do not have this requirement Please refer to these definitions, if applicable. !.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall J
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
I
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
I 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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:.
ittee or Designee)
Page 1 of 2
SWU-242, Lastmodl0ed 10/25/2012

1. Outfall Description:
Outfal] No. 002 Structure (pipe, ditch, etc.) . Concrete -pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area: - -
Roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc) and tint
(light, medium, dark) as descriptors:- Chi 4/Z
3. Odor: Describe any
weak chlorine odor, etc.):,_
that the discharge may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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 1 is no solids and 5 is extremely muddy:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes 6D
9. Is there evidence of erosion or deposition at the outfall? Yes ' ND
10. Other Obvious Indicators of Stormwater Pollution:
List and describe COUCCTt'b ,tiZ LC (-141) 61CA SS C
70 Si[nn1=wl LIFA,;:/ i?Al.vI-A-LL
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 modifled 10/25/2012

Chain of Custody Record (COC)'
J
NPDES#: NC1)pG273a5
p /P E I TE C H, INC.
NC.
Client:_ Fehr Crrn i7nm
Address: "i31 E. moan ST
Phone:1815) ci 35-7t94
Fax:- L 51-a35-4(n.3
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email; [e-mail]
Eh -i r i nl
I
_D ,icy-: • I[�j
v
Attention: T
0.tr mbfo nr �mhx m.�oM
Email:.mca.�+«@Pikltrvvbei: Qom
Project:JqctCh Kubber!' �/Y7
P:0 it -
Turn Around Time*
www.meritechlabs.com
Sampling Dates & Times
Sample Location and/or ID ri Start End
_ _
Date Time Date Time
-�jio i$ 3':3�-iltoi+8 3•.33�
How would you like your report sent? 'RUSH work needs prior approval.
Circle all that apply: mai refs red), Fax, Mail 5td IO da ) 3-5 Da 1 24_aaNr
o
Person Taking Sample (Sign/Print):
Lab Use Only
Comp?
Grab?
(�7-
Hof
Cont.
Test(s) Required
On� N
Yes
pH OK?
Cl OK?
OF
ko l r8
3'.3
�koNB
3:
Cr
a
-
-
--
I
i
Temperature Upon
Method of
Shipment:
•'• Dechlonnatlon e0.5-
( Pm) of Ammonia; C snide Phenol
Comments:
and TKN samples must be done in the field
Recelpt:
rior to preservation. •••
Compositor #
❑ ups
❑ Fed Ex
Li Hand Delivery
DO Other
D1C YT +D
Are these results for regulatory.
; purposes?Yes . �- -
Relinquishedby: - - ./1 Dal o •' Time:
l..(ti+..i'
Relinquished by: pate: Time:
Relinquished by: Date: Time:
_ lug #
No ❑ .Report results in: mg/L tb� mg/kg ❑, ug/L ❑
i i, Received by: - /
y0✓y. /% 7 ;e:1 � Time; s Y'
iecelved by: Date: ilme:
Received by lab: Date: time:

FEHRGRLL",'�N!
ENGINEERING & ENVIRONMENTAL
Certified Mail No. 7017 0190 0000 2198 5141
Return Receipt Requested
July 11, 2018 RECEIVED
JUL 18 2018
Division of Water Quality
Attention: Central Files CENTRAL FILES
1617 Mail Service Center DWR SECTION
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - June 2018
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
® water discharge from the above -referenced facility for June 2018.
2 Please note the following:
0
° The facility was not able to collect the required samples from a "Representative
v
m
Storm Event" for the month of June 2018.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
" —FAL Y1l[. _A3
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosure
cc: Marto Carter, Patch Rubber Company
O:\Patch Rubber Company\18-105\PA Final\18-105 -Storm Water SDO June 2018 Cover Letter.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCIIARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
OutfaB •
No. •
i•. -,Collected
Date
Sample
50050
''
Total -.
Flow ifn.Rainfall
;total`-.� --.
a
,,
pH
COD k :'
Zlnc.'
t.'mo/dd/
r'-
MG -.,L• ->
inches.,.
mg,..L. .-;
;.mg-,li r
001
N/A
002
N/A
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfa❑
Date "'} -. `.
50050 _.( -
- - •
00556
ii.
F00530..
-00400
Flow:
Total^
Oil & Greasti
Non-polar '`-'Total
- -
Of
�New Motor.
No.
Sample '-,Total
.Collected
(if applicable)
;Rainfall
(ifappl.)
OSG/I"PII P
�Suspended�.�
'OilUsage =�s
,;
e,
@4eiGoa lG6a
So ids
1tftf
'mo/dd/'yr
MG I .-inches
-
m /l
V
Imo
unit-
gaunu;
Form SWU-247, last revised 21212012
Page] of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable— see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of 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 mann system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowle e a belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the poobilili of fines and imprisonment for knowing violations."
of Permittee)
i
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of June 2018. "No Flow"
Form SWU-247, lust revised 21212012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring; Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 7/13/18
CERTIFICATE OF COVERAGENO. NCG030325
FACILITY NAME HickorySteel
COUNTY Catawba
PERSON COLLECTING SAMPLES Chris Wolf
LABORATORY Prism Lab Cert. # 402
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
❑ No discharge this period?z
SAMPLE COLLECTIONYEAR 2018
SAMPLE PERIOD[:] Jan -June❑ July -Dec
or®Monthly'June (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
❑Other RECEIVED
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 34 JUL 24 2018
CENTRAL FILES
DWR SECTION
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organicss
Benchmarks =__>
-
-
100 mg/L or 50 mg/L4
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
01
6/26/18
0.187
0.012
0.14
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'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.
4 See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
sTotal Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date:11/1/2012-10/31/2017
SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan mayso certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Chris Wolf
Name (Print name)
Safety Manager
Title (Print title)
C&i:& —I 11311 S
(Signature) (Date)
Note: Results must be reported in numerical format.Do not reportBelow 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.
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.
Part 13: Vehicle Maintenance Area Monitoring Results: only for facilities averaging> 55 gal of new oil per month.
No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches;
Non -polar O&G/TPH by
EPA 1664(SGT-HEM)
Total Suspended Solids
pH
Benchmarks ===>
_
-
15 mg/L
100 mg/L or 50 mg/L`
6.0 — 9.0 Su
Footnotes from Part A also apply to this Part B
' See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
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.
Permit Date:11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

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 DWQ REGIONAL OFFICE?YES ® NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR,including all "No Discharge" reports, within 30 days of receiptof the lab results for at end of monitoring period
in the case of "No Discharge" 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."
(Signature of Permittee)
-71%'61(?D
(Date)
Permit Date:11/1/2012-10/31/2017
SWU-245, last revised 10/25/2012
Page 3 of 3

`n
FEHRGRAJ-11 N
ENGINEERING & ENVIRONMENTAL
UPS Overnight Tracking No.: 1Z 651 395 01 5565 5180
June 14, 2018
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
JUN 15 2018
CENTRAL FILES
GV'JR SECTIO'.'
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - May 2018
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for May 2018.
Please note the following:
• Storm water samples were collected during a representative storm event on
May 16, 2018.
• The results for zinc are above the facility's permit benchmark for Outfall 001 N.
• The facility has already implemented its Tier 2 response and will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
ia',-t —rAj_ ,-r,l _)
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosures
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\18-105\PA Final\18-105 -Storm Water SDO May 2018.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

Permit Number NCS 000325
FACILITYNAME Patch R
PERSON COLLECTING SAMP
CERTIFIED LABORATORY(S)
Part A: Specific Monitoring Requirements
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
w
SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
(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 Halifax
PHONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
fYkl©fliklii-�-
11
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Requirements
Outfa0
No.
i
.Date
Sample
Collected
50050
1. - - - -
00556-
00530. -
00400
-
Total Flow
(if applicable)
Total
Rainfall
-
Ij
'Oil & Grease
(if appl.)
Non -polar -
O&GJTPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
_
mo/dd/ r -
MG- -
inches
m 1 -
- - -
m
unit
2avmo
-
1
Form SWU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date 05/16/2018
Total Event Precipitation (inches): 0.26
Event Duration (hours): (only i1
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
see permit.)
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.assuye that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who mama a the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my kmowled� and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the posl nluy of fines and imprisonment for knowing violations."
of
(Date)
Form SWLJ-247, last revised 21212012
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: "-''—
Client: Fehr Graham
220 Pra4xJeSt, Suite 208 C�yp�y31.-
Rockfor107
Meritech Work Order # OS1618101 Sample: OF 001 N Grab
Parameters Results Analysis Date
COD <15 mg/L S/16/18
Zinc, total 0.292 mg/L 5/18/18
Meritech Work Order # 051618102 Sample: OF 002 S Grab
Parameters Results Analysis Date
COD <15 mg/L 5/16/18
Zinc, total 0.050 mg/L 5/18/18
Report Date: 5/24/2018
NPDES#: NCS000325
Project: Patch Rubber Co.
Date Sample Rcvd: 5/16/2018
5/16/18
Reporting Limit Method
15 mg/L EPA 410.4
0.010 mg/L EPA 200.8
5/16/18
Reporting Limit Method
15 mg/L EPA 410.4
0.010 mg/L EPA 200.8
I hereby certify that I have reviewed and approve these data. /(-
9z
Laboratory Rep esentative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

NCDENR.
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfilling out this(orm,please visit: Sftp,t[portal.ncdeni-.oLgAyab/w4`/ws/su/nod6,ssw#iab-
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber -Company— --
County: Halifax Phone No. 252-536-2574
Inspector: K- -- - - --- - -
Date of Inspection:_ r-s tto� 1`a
Time of Inspection: - q 5q 0 M
Total Event Precipitation (inches): . 210*'- ? N ' Lm--��
Was this a "Representative Storm Event" or "Measureable Storm Event' as defined by the permit?
(See information below.)
n Yes ❑ No
Please verify whether Qualitative Monitoring -must be performed during a "representative storm
event' or "m easureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
:III some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall .�
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
( 0A inches has occurred. A single storm event may contain up to 10 consecutive hours of no
I precipitation.
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
1 interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local_DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
or Designee)
Page 1 of 2
5 W U-242, Last modified 10/25/2012

r__..------ i:-- OutfhIIDescription:--- --
Outfall No. 001 Structure (pipe, ditch, etc.), Concrete pipe
Receiving Stream: Unnamed tributary. to -Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North oarkina lot, roof drains --
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: 1-1 1 A
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N1 1 A
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 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:
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.
Is there any foam in the stormwater discharge?
Yes
Ho
8.
Is there an oil sheen in the stormwater discharge?
Yes
9. Is there evidence of erosion or deposition at the outfall? 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, Lastmodified 10/25/2012

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance onfilling out thisform, please visit- hup, /tiortalncdenrorg/weblwq /wc/syJnodmw#tab•4
Permit No.: or Certificate of Coverage No.: hViLlfc/—/_/_/—/—/—/
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252_536-2574.
Inspector: _ ter\ ��_ `C� —
Date of Inspection: tit t i12
Time of Inspection:
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
© Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
i Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
Jperformed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
1 A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the j
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 DWQ Regional Office.
By this signature, I cej-tify that this report is accurate and complete to the best of my knowledge'.
of PIAmittee or Designee)
Pagel of 2
SWU•242, Last modified 10/25/2012

1. Outfall Description:
OutfallNo. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area;
Roof-drains-
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: r A.k
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): - N lA - - - - -
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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 1 is no solids and 5 is extremely muddy:
(T2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes ©o
10. Other Obvious Indicators of Stormwater Pollution:
List and describe NN \A - —
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, Lastmodified 10/25/2012

5 Y106 Chain of Custody Record (COC)
NPDES#: M-50003a5
MERITECHINC.
ENVIRONMENTAL LABOR
\ LABORATORIES
.�
i
\ 642 Tamco Rd. Phone: [phone]
u
Client: Ec-t: (xrCU-tom Phone: 235-7(a4,3
Address: c E. rYlaan si Fax: _(86) a35-4(p-'
0.ti4Mb6Qichr.gmtllrmcam.
�'MCPO `{-I —R Ln(O� Email: rnwr{ere PafchZber. corn
PCCJ>Cc1"� Icl:-�) Project:{krF'Ch RUbUer-l'n i
Reidsville NC 27320 Fax: , 336-342-1522
P O.#:
Email: [e-mail]
www.meritechiabs.com
Attention: m -F ) Turn Around Time'
•
How would you like your report sent? RUSH work needs prior approval.
Circle all that apply_ Ema-apreferred), Fax, Mail Std 10days) 3-5 Days �a�aa�Hs
L�
Sample Location and/or ID #
Sampling Dates
P g
Person Taking Sample (Sign /Print):
Lab Use Only
Start
End
Comp?
Grab?
qof
coot.
Tests) Required
/ No
Yes es N
pH OK?
Cl OK?
Date
Time
Date
Time
Fncn V
G
OF 00
5\l(.�06
tp'-ozw
5VwWa
to-cx
(?
a
---------------------
Temperature Upon
Receipt:
Method of
'#` Dechiorination (<.O.S m) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field prior to preservation.
d�
Shipment:
Comments: Compositor #
Jug #
Are these results for regulatory purposes? Yes IX No ❑ ReceRepo I rt results in: mg/L � mg/kg ❑ ug/t ❑
Relinquished by: Date: Time:
, s •, y 2 oM S ate% / Time:
Relinquishe ate• Time: eceived yl Date::: , Time:
❑ UPS
❑ Fed Ex
❑ Hand Delivery
® Other
i inquished by: Date: Time:
y,
Recei ILA : Da TlmeI to

FEHRGRA.",'A
ENGINEERING & ENVIRONMENTAL
UPS Tracking No. 1Z 651 395 03 5591 1729
RECEIVED
May 10, 2018 MAY 15 2018
Division of Water Quality CENTRAL FILES
Attention: Central Files OWR SECTION
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Storm Water Discharge Outfall (SDO) Monitoring Report - April 2018
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for April 2018.
(D Please note the following:
• Storm water samples were collected during a representative storm event on April
a
24, 2018.
v
• The results for zinc are above the facility's permit benchmark for Outfall 001 N
and Outfalls 002 S.
• The facility has already implemented its Tier 2 response, and will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
al-y1_d TA-VYYId_A_)
Amy L. Trimble, CHMM
Environmental Scientist
ALT:dld
Enclosures
cc: Mario Carter, Patch Rubber Company
0:\Patch Rubber Company\18-105\PA Final\18-105 - Patch Rubber & NC Div of Water Quality - 2018-05-08 -Storm Water SDo
April 2018.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber CompanV
PERSON COLLECTINGSAMPLE(S)_ Marjo Carter
CERTIFIEDLARORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2018 '
(This monitoring report shall be received by the Division no later than 30 days front
the date the facility receives the sampling results from the laboratory.)
COUNTY Halifax
PHONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE Olt DESIGNEE
REQUIRED ON PAGE 2.
1--®--®-
Date
Sample
Collected
olal
F Im, (if app.)
1 1
04/24/ZO18
—��®�---
04/24/2018
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part 13)
Part R: Vehicle Maintenance Activity Monitoring Requirements -
Outfall
No.
Date
Sample
Collected
50050
00556
00530 - -
06400
Total Flow
(if applicable)
'Total
Rainfall
Oil & Grease
(if appl.)
Non -polar-
O&G/TPII
(Method 1664
SGT-IIEM), if -
a 1.
-Total ,-
S�irspended
Solicls
pit - -
Noy Motor
Oil Usage
mo/dd/vr
MG
inches
mg/I
mg/1
unit
al/nlo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 04/24/2018
Total Event Precipitation (inches): 0.2
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, tinder penalty Wow, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assut,tat qualified personnel properly gather and evaluate the information submitted. Rased on my inquiry of the person
or persons who manaee tin e system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledg$e a d belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the poso )ility of fines and imprisonment for knowing violations."
Permittee)
s it Ily
(Date)
Form S W U-247, last revised 21212012
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Brian Paluzzi
Client: Fehr Graham
220 Prairie St, Suite 208
Rockford, IL 61107
Meritech Work Order # 04241873 Sample: OF 001 N Grab
Parameters Results Analysis Date
COD <15 mg/L 4/25/18
Zinc, total 0.531 mg/L 5/1/18
Meritech Work Order it 04241874 Sample: OF 002 S Grab
Parameters
Results Analysis Date
Report Date:
5/3/2018
NPDES #:
NCS000325
Project:
Patch Rubber Co.
Date Sample Rcvd:
4/24/2018
4/24/1.8
Reporting Limit Method
15 mg/L EPA 410.4
0.010 mg/L EPA 200.8
4/24/18
Reporting Limi Method
COD <15 mg/L 4/25/18 15 mg/L EPA410.4
Zinc, total 0.108 mg/L _ 5/1/18 0.010 mg/L EPA 200.8
t hereby certify that / have reviewed and approve these data.
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Hm.
Chain of Custody Record (COC)
NPDES#:-[C5 CCb3a5
MERITECH, INC.
Client: Fehr 7YYt) 3 m
Phone: (815)a35-7U43
d
Address:QM1 E mean si
Fax:[phone](o33,
ENVIRONMENTAL LABORATORIES
13=42 r�l -n
0.tr"imbtG-Q4chr- r2tYfM.Corn
96b�!r.
�0
rL Ip�
Email: mcarrer@pgt� �o
642 Tamco Rd. Phone: [phone]
—.PLY?JC�: )Cjj
Project:PatCJ-1
Reidsville NC 27320 Fax: [phone]
P.O:#:
Email: info@meritec�ilahs.com
Attention: rn T
Turn Around Time -
www.meritechlabs.com
How would you like your report sent? 'RUSH work needs prior approval.
Circle all that apply_ Email referred), Fax, Mail Std 106s) 3-5 Days 2:
Sampling Dates &Times
Person Taking Sample lSign/Print):
Sample Location and/or ID #
Lab Use Only
Comp?
itof
Test(s)
Required
Ice?es
pH
Start End
Date - Time Dale
Time
Grab?
coot.
YOn
Yes / No
Cl OK?
K?
1
4j Z�lib
e•55n
L112V
1'crx�n
G-
,
OF oca 5tit2v�18
j
Temperature Upon
Method of
Dechlonnnation (<0.5 m of Ammonia, Cyanide, Phenol and TKN samples must be done In the field
Receipt: •�,
rior.to reservation. ••*
Shipment:
Comments:
=
Compositor #
❑ UPS
❑ Fed Ex
❑
Are these results for regulatory purposes? Yes 0
Relinquished by�,7 /�
kk��,, Jug#
No ❑ Report results in: mg/L td.l mg/kg ❑ ug/I. ❑
Hand Delivery
f
GU �.4YLr2'� Date• Time: Received b
yl (S �;j,`Il7J �'i
t � Time:
® Other
Relinquish e: Tim
' :
-7 Received by:
7
_
ate: Tme:
1
Relinquished b . Date: Time:
Recely d by
a Time:
Z'` T�
U

. NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forgufdance on filling out this form, please visit.,h tmlZnuiai.ncddnr org/w /wq/ws%su/npdesswktab=4
Permit No.: r[/�/�/Q/Q/�/3 /2/ 5/ or Certificate of Coverage No.:
Facility Name: -Patch Rubber Company --- - -- - --- -
County: Halifax Phone No. 252-536-2574
Inspector:
Date of Inspection: y Zy\ \ R
Time of lnspectiom . �'•�Oarn _ - _- _- _ -- - _- _ _ -
Total Event Precipitation (inches): • 2-
-O
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.) ,
® Yes ❑ No
Please verify whether Qualitative Monitoring must he performed during a "representative storm
event' or "measureahle storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than .
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature, ISertify that this report is accurate and complete to the best of my knowledge: .
rmittee' or Designee)
Pagel of 2
SWU•242, L=madifled 10/25/2012

-- - -- - -1:- - Outfali Description:-
Outfall No. 001 Structure (pipe, ditch, etc.) Concrete _pipe
Receiving Stream:. Unnamed tributary to Roanoke River ---
Describe the industrial activities that occur within the outfail drainage area:
North parking lot, roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: t-4 l A
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): NAk#N
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
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 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
B. Is there an oil sheen in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Yes No
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, Lastmodifled 10/25/2012
t

kvlwj
om� /aa
NC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out thisform, please visit: (g;tli'//oortatnciieiir:ore/w �/wg/ws/cy/itpdessw#tali-4
Permit No.: or Certificate of Coverage No.: NfC/Sl—/_/—l_l _/—/
Facility Name: Patch Rubber Coml2any
County: ..Halifax- —___ _ .Phone No. 252-536-2574
Inspector: LnY-Ae--\
Date of Inspection: L A\tom - Time of Inspection: Ito o rn
Total Event Precipitation (inches): . 2 Ft•\ 1a_5
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
R Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature; Vc rtify that this report is accurate and complete to the best of my knowledge:
of rermiRee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.).- Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
Roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: N \A — — — — --
3. Odor: Describe any distinct odors that the discharge may have (Le., smells strongly of oil,
weak chlorine odor, etc.): N k A - - - - -
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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) 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. Is there any foam in the stormwater discharge? Yes
8. is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes GD
10. Other Obvious Indicators of Stormwater Pollution:
List and describe tom\ W
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.
ti
z
Page 2 of 2
SWU-242, (.=modified 10/25/2012
f
i

-m16 Chain of Custody Record (COC) NPDES#: A
MERITECH, INC. Client: &bh -rr=rn Phone: (815 bn 3135-7r
9 Address:► E. rr)o�n �a Fax:-a5� `a35-403R
_ ENVIRONMENTAL LABORATORIES Frrr -Tit i'ni atr'imb)cGfchr-.q.+ tw= rt.cefn
- Email: mcarfe�&. a&-h bber. Born
642 Tamco Rd. Phone: 33fi-342-4748 nrc�ir�3-: Im. Pro eCt:
u 1Ch <iubber�nrnr»
'k.6t Reidsville NC 27320 Fax: [phone]
Email: info@meritel•hlabs.com Attention:-RmqTjjb2l2jCj Turn Aroundnme•
How would you like your report sent? 'RUSH work needs prior approval.
www.meritechlabs.com si�d�.tD. ESr�) 3-5 Da r74-aa Hm
Circle all that apply: mal referred), Fax, Mall I x l
Sampling Dates & Times Person Taking Sample (sign/Print):
Sample Location and/or ID # Lab Use Only
Start End romp? # of o=Ice?pH K?Date Time Date Time Grab? Cont. Tests) Required Ye?
Method of
Shipment:
"•Dechlorination <0.5Dom) ofAmm
Comments: '
] UPS
] Fed Ex
Are these results for regulatory purpc
] Hand Delivery
Relinquished by:
Other
Rellnquished by:
Yes I$I No
Date: Time:
Date: Time:
must b
slug #
.Report results In: mg/L OKI mg/kg Q u
Received by: - Date: Tim
Recelyed by: Date: Tim
Received by Lab: Date:, nin
"- __ �.�,... ,,,.-...... _..-..,....,_.F.....,�_ a ........» .

FEHR GR�'.�,'�NI
ENGINEERING & ENVIRONMENTAL
UPS Ground Tracking No.: 1Z 651 395 03 5742 9588
April 10, 2018
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - March 2018
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for March 2018.
ED Please note the following
• Storm water samples were collected during a representative storm event on
a March 6, 2018.
v
v
• The results for zinc are above the facility's permit benchmark for Outfall 001 N
and Outfalls 002 S.
• The facility has already implemented its Tier 2 response, and will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
--�.,�:tf,LA-o
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosures
A�9 ,
CY
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\18-105\PA Final\18-105 - Storm Water SDO March 2018.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITY NAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) Marlo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
(This monitoring report shall be received by the Division no later that 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfill
No.
Total
rotud
----------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/1'PH
(Method 1664
SGT-ITEM), if
appl.
Total
Suspended
Solids
PH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m /l
m /I
unit
al/nto
Form SWU-247, last remised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 03/06/2018
Total Event Precipitation (inches): 0.15
Event Duration (hours): (only if applicable— see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Piles
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 ass'�,�/t�, that qualified personnel properly gather and evaluate the information submitted. Rased on my inquiry of the person
or persons who m:m vIlre system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowlejtge {{{nd belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the po ibil v of fines and imprisonment for knowing violations."
of Permittee)
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
;4
Laboratory Certification No.165
Contact: Brian Paluzzi
Client: Fehr Graham
220 Prairie St, Suite 208
Rockford, IL 61107
Report Date:
NPDES #:
Project:
Date Sample Rcvd:
3/16/2018
NCS000325
Patch Rubber Co.
3/7/2018
Meritech Work Order #
030718136 Sample:
OF 001 N Grab
3/6/18
Parameters
Results
Analysis Date
Reporting Limit
Method
COD
<15 mg/L
3/8/18
15 mg/L
EPA 410.4
Zinc, total
0.299 mg/L
3/12/18
0.010 mg/L
EPA 200.8
Meritech Work Order #
030718137 Sample:
OF 002 S Grab
3/6/18
Parameters
Results
Analysis Date
Reporting Limit
Method
COD
22 mg/L
3/8/18
15 mg/L
EPA 410.4
Zinc, total
0.154 mg/L
3/12/18
0.010 mg/L
EPA 200.8
I hereby certify that I have reviewed and approve these data. 4, &i _
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Chain of Custody Record (COC)
NPDES#:_NCS QQ�)3a5
MERITECH, INC, Client: 1= bcCTram - Phone: LbiZa35-7co43
Address: ) E rYlour-) �- Fax:_(815)
ENVIRONMENTAL LABORATORIES �nf,r { —fr �elU Email:0.hr;MWCQ-fchr•q,Urawm.conn
---�-��+ �,per. f�m
642 Tamco Rd Phone336- 4 • --
,. . 3 2-4748
Reidsville NC 27320 Fax: [phone]
Email: [e-mail] Attention:
DR3
How would you like your report sent? Email
www.meritechlabs.com Circle all that apply. referred), Fax, Mail
Sampling Dates &Times Person Taking Sample (Sign/Print):
Sample Location and/or ID # Start End
Comp? #of
Date I Time I Date Time Grab? Cont.
Method of "" Dechlorinatlon I
Comments:
] UPS
Fed Ex Are these results for
Other I Relinqulsh¢dby:
urposes? Yes X No ❑
Date: Time: Received
� to: l�"
'3 ' Time: C L' Received
Date: Time IReceived
Test(s) Required
)D \'3C
Turn Around Time'
•RUSH work needs prior approval.
Lab Use Only
On Ice? pH OK?
yes / No CI OK?
Temperature Upon
Receipt:
.to preservation. "' v
Compositor #
Lug g#
In: mg/L 1Z mg/kg ❑ ug/L ❑
,7 }%1 S� Timer of l

r FEHRGRA. NAM
ENGINEERING & ENVIRONMENTAL
UPS Tracking Number: 1Z 651 395 03 5692 9192
March 8, 2018
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
OR 19 2u'tb
CENTRAL FILES
tib11R SFCT10N
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - February 2018
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for February 2018.
(s Please note the following
• The facility was not able to collect the required samples from a "Representative
a Storm Event" for the month of February 2018.
v
w
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Gt"t TA�LrMUL-P-)
Amy L. Trimble, CHMM
Environmental Scientist
ALT: m l l
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\18-105\PA Finat\18-105 -Div of Water Quatity - SDO February 2018 Cover Letter.dooc
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www,fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
ii FACILITYNAME_�Patch'Rubber 'ComoanV
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) -._-Lob #-
- Lab # .
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: _ 2018
(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. Halifax
PHONENO. 2( 521536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than SS gallons of new motor oil per month? _ yes Xno
(if yes, complete Part B)
Part R['Whicle Mnintennnep. Artivity Afnnitniinn Romiirrmnnrc __
Outfa6
No.
Date
Sample
Collected
50050
:.
00556.:. _
,.::,:
Gem
80/00 .
Total Flow
(if applicable)
Told :
Raiafs6.
OR & Grease
(IfeppL)
�.•
n,..
Non -polar'--
O&C/I'PH;, �
(A1etAoA�1664�
s- .:nr
v
Total - .. �. � �. ;
Suspendedr" '
Sollds'z ;::- ;�
,
pH i
t, ��
:
.New Motor
OBUsare
_
molddtvr _
MG
Inches.
MO.M60.unit
o
Form SWU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under pen ty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed t sure that qualified personnel properly gather and evaluate the information submitted. Based on my Inquiry of the person
or persons who nagc the system, or those persons directly responsible for gathering the information, the Information submitted is, to the
best of my kn edge and belief, true, accurate, and complete. I am aware that there are sigulflcant penalties for submitting false information,
Including thYv6ssibiliry of fines and imprisonment for knowing violations."
(Date)
the Facility was unable to collect the required 'samples from a -"Representative Storm Event"
for the month of February 2018. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

FEHR GRAW-1 �M
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7016 0750 0000 0684 3579
Return Receipt Requested
February 7, 2018
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - January 2018e+
Patch Rubber Company RECEIVE®
100 Patch Rubber Road
Weldon, INC 27870 FEB 2 1 2018
NCS000325
Dear Sir/Madam:
Ur-N i RAL FILES
DVVR SECTION
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for January 2018.
5%
Please note the following:
0
o The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of January 2018.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
rA M"1
Amy L. Trimble, CHMM
Environmental Scientist
ALT: m 11
Enclosure
cc: Marto Carter, Patch Rubber Company
0APatch Rubber Company\18-105\PA Final\18-105 - Div of Water Quality - Storm Water SDO January 2018 Cover Letter.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000323 SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
(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.)
FACILITYNAMF. Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LARORATORV(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PIIONENO. 2( 521536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00530
00400
Total Flow
(ifapplicable)
Totalase
Rainf
j0i0i556
Non -polar
O&G/TPH
(Method 1664
SGT-I-IEM), if
Total
Suspended
Solids
PH
NewMotor
Oil Usage
mo/dd/vr
MG
inche
m g/I
unit
al/mo
Form S W U-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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 belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the possi11 ay of fines and imprisonment for knowing violations."
Permittce)
.2
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of January 2018. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

t . .
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
(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 Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERM ITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-HEM), if
appl.
'Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
mg/1
m /I
writ
al/mo
Form SWU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (lours): (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 tinder 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 an , true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibil' off es and imprisonment for knowing violations."
/0&f-1-4e
(Signatur of Permittee) (Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of September 2018. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

FEHRGRAW-1 M
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7017 0190 0000 2198 5479
Return Receipt Requested
September 10, 2018
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - August 2018
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for August 2018.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of August 2018.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
" TA�Lrmu-k-) RECEIVED
Amy L. Trimble, CHMM 2 201�
Environmental Scientist $EP
ALT: mll per$ CTION
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\18-105\PA Final\18-105 - Div of Water Quality - Storm Water SDO August 2018 Cover Letter.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I �.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
----------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Ac ivitV Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00530
00400
Total Flow
(if applicable)
'TotalGreaseNan-polar
RainfallO&G/I
rn
P[I
(Method 1664
SGT-IIEM), if
a I.
Total
Suspended
Solids
pll
New Motor
Oil Usage
mo/dd/ r
MG
inches
m I
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable— see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of 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 man a the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my know a and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the o ibility of fines and imprisonment for knowing violations."
'T/, 7/1?
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of August 2018. "No Flow"
Form SWU-247, lost revised 21212012
Page 2 of 2

{
Bestway South,Inc.
165 Halyburton Road
Stony Point, NC 28678
October 11,2018
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699 - 1617
RECEIVED
OCT 16 2018
CENTRAL FILES
OWR SECTION
Re: Submission of Stormwater Discharge Outfall Monitoring Report (DMR)
Bestway South, Inc. (Iredell County)
NPDES SW Permit NCS000328
Dear Storm water Permitting Unit;
We respectfully submit the enclosed original and one copy of the Stormwater Discharge Outfall
Monitoring Report for Bestway South, Inc., NPDES Stormwater Discharge Permit NCS000328. This
submission is for storm water discharge #1, sample # 16.
This sampling reflects guidelines per our previous permit. We have still not received a new permit. We
are sampling as though we had our new updated permit in place. This particular collection was during
hurricane Florence. Most of our results were better than previously, with the exception of copper. Our
pH level was low for whatever reason this time. It has been running very consistent. In response to our
copper benchmark value being above limit, we are continuing with our Tier Two response as outlined
in our permit. I now will re -sample at the next possible rain event which produces an outfall. The Tier
Two response will be documented in our storm water pollution prevention plan as required. As
always, our copper level, will always be above the benchmark due to our process water we receive
from the county has a higher copper level than our benchmark allows us.
Respectively submitted,
Richard Petrovich
General Manager
Bestway South, Inc.
Enclosures: Stormwater Discharge Outfall Monitoring Report (DMR), 1 original & 1 copy

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCS 000328 SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
CERTIFICATE OF COVERAGE NO. NCG: (This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME_Bestway South, Inc. COUNTY Iredell
PERSON COLLECTING SAMPLE(S) Richard Petrovich (GM) PHONE NO. ( 704 ) 585 - 6373
CERTIFIED LABORATORY Statesville Analytical Lab #37755
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/ r
Total Arsenic
m
Total Chromium
mgfL
Total Copper
m L
BOD5
m
Benchmark
-
0.36
1
0.007
30
SDO-001
09/15/18
.062
.1
.33
8
Sample 16
00530
00400
Total Suspended Solids
m
Total Nitrogen
m
pH,
Standard units
COD
m
too
30
Within 6.0 - 9.0
120
13.125
1.9
3.29
49
Did 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 x no
Outfall
No.
Date
Sample Collected,
mo/dd/ r
00556
00530
00400
Oil and Grease,
m
'total Suspended Solids,
m /L
pH,
Standard units
New Motor Oil Usage,
Annual average al/mo
Benchmark
30
100
6.0 - 9.0
S W U-246-112608
Page I of 2
Oa_i t�iv A L,

STORM EVENT CHARACTERISTICS:
Date 09/15/2018
Attn: DWQ Central Files
Total Event Precipitation (inches): 4. 00"
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
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 fineaad,ittiprison ment for knowing violations."
of
de
(Date)
SWU-24ff- 112608
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCS 000328 SAMPLES COLLECTED DURING CALENDAR YEAR: 2018
CERTIFICATE OF COVERAGE NO. NCG: (This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME Bestway South, Inc. COUNTY Iredell
PERSON COLLECTING SAMPLE(S) Richard Petrovich (GM) PHONE NO. ( 704 ) 585 - 6373
CERTIFIED LABORATORY Statesville Analytical Lab #37755
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
Outfall.
No.
Date
Sample Collected,
mo/dd/ r.
Total Arsenic
m
Total Chromium
m
Total Copper
m
BODs
m
Benchmark
0.36
. 1
0.007
'30-
SDO-001
09/15/18
.062
.1
.33
8
Sample 16
00530
00400` _
Total Suspended Solids
r "m
Total Nitrogen,
m
-",pH,:
` Staridard'units`
m
100
30
Within 6.0-= 9.0 -
120
13.125
1.9
3.29
49
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes x no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall.
No
Date,
Sample Collected,
mo/dd/ r-' .
00556,,
00530
00400 .
Oil and Grease, '
- m _
Total Suspended Solids,
. '` m'
pH,
Standard units'
New Motor Oil Usage,
'Annual aveia a aUmo
Benchmark
30 . '
100 ' :.` .
.6.0 r 9.0
SWU-246-112608
Page 1 of 2
COPY

STORM EVENT CHARACTERISTICS:
Date 09/15/2018
Attn: DWQ Central Files
Total Event Precipitation (inches): 4.0011
Date _ (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
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 fine ' nprisonment for knowing violations."
of
/a /' / op
(Date)
SWU-246-112608
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) Marlo Carter
CERTIFtEDLABORATORY(S) Pace Analytical Lab# 0
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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 Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REOUIRED.ON PAGE 2.
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitorin, Requirements
Outfall
No.
Date
Sample
Collected
50050
100556
1
00530 1
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/I'PH
(Method 1664
SGT-HEM), if ..
atipl.
Total I
Suspended
Solids I
pH
New Motor
Oil Usage
mo/dd/vr
MG
inches
mg
mg1l I
unit
-'al/mo
Form SWU-247, fart revised 21212012
Page 1 of?

I
STORM EVENT CHARACTERISTICS:
Date 11/19/15
Total Event Precipitation (inches): 0.44
Event Duration (hours): (only if applicable — see permit.)
(if more than one stomi 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
Attu: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under lienalty of law, that this document and all attachments.were prepared under my direction or supervision in accordance with a
system designced 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)c towledge 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."
(2 /1J 1j'
(Date)
Foam SWU-247, last revised 21212012
Page 2 of 2

W,
` FEHR GRL:ri,'�M
ENGINEERING & ENVIRONMENTAL
UPS Tracking Number: 1Z 651 395 02 5676 9429
January 10, 2018 JAN 19
2018
Division of Water Quality DWR SECTION
Attention: Central Files INFORMATION PROCESSINGUNI7
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - December 2017
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for December 2017.
Please note the following:
The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of December 2017.
The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosure
cc: Marto Carter, Patch Rubber Company
O:\Patch Rubber Company\18-105\PA Final\NC Div Air Quality - Storm Water SDO December 2017 Cover Letter.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I wv ,fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITFEE ORDESIGNEE '
REQUIRED ON PAGE 2. ���
i
----�--
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitorinp Reouirements
Outfail
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/vr
MG
inches
m
m
unit
al/mo
Form S WU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable —see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of Is that this document and all attachments were prepared under my direction or supervision in accordance with a
ssure th! i q
system designed to aualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge�add belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the possitjd-6 of Imes and imprisonment for knowing violations."
(Signature
Of
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of December 2017. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

FEHRGR�'" M
ENGINEERING & ENVIRONMENTAL
UPS Ground Tracking No. 1Z 651 395 03 5549 0827
December 12, 2017
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
� cEsVED
DEC j. Q 2917
CENTPAL FILCS
OwR SEC r10N
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - November 2017
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for November 2017.
Please note the following:
• Storm water samples were collected during a representative storm event on
November 8, 2017.
• The results for zinc are above the facility's permit benchmark for Outfall 001 N
and Outfalls 002 S.
• The facility has already implemented its Tier 2 response, and will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
(),r,-YLd -r t MU 0
Amy L. Trimble, CHMM
Environmental Scientist
ALT: did
Enclosures
cc: Mario Carter, Patch Rubber Company
0:\Patch Rubber Company\17-105\FinaIWLT 17-105 - Storm Water SDO November 2017.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(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.)
FACILITYNAME Patch Rubber Company COUNTY Halifax
PERSON COLLECTINGSAMPLE(S) Marlo Carter - PHONENO. 2521536-2574
CERTIFIED LABORATORY(S) Pace Analytical Lab a4Q_ _
Lab N
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Acquirements
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorins. Reauirements
Outfin
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(fappL)
Non -polar
O&GITPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
OBUsage
mo/d
MG
inches
me
MRA
unit
gultino .
Form SWU.247, last revised 21212012
Page I of 2

0
STORM EVENT CHARACTERISTICS:
Date 11/08/2017
Total Event Precipitation (inches): 0.21
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours); (only if applicable — see permit.)
Mail Original and one copy to:
Division of 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 man k the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my kuo� 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."
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

Meritech, Inc.
r • Environmental Laboratory
Laboratory Certification No.165
t
Contact: Brian Paluzzi Report Date: 11/22/2017
Client: Fehr Graham NPDES #: NCS000325
220 Prairie St, Suite 208 Project: Patch Rubber Co.
Rockford, IL 61107 Date Sample Rcvd: 11/9/2017
Meritech Work Order # 110917149 Sample: OF 001 N Grab 11/8/17
Parameters
Results
Analysis Date
Reporting Limit
Method
COD
<15 mg/L
11/10/17
15 mg/L
EPA 410.4
Zinc, total
0.383 mg/L
11/20/17
0.010 mg/L
EPA 200.8
Meritech Work Order # 110917150 Sample: OF 002 S Grab
Parameters Results Analysis Date
COD <15 mg/L 11/10/17
Zinc, total 0.124 mg/L 11/20/17
I hereby certify that I have reviewed and approve these data.
11/8/17
Reporting Limit Method
15 mg/L EPA 410.4
0.010 mg/L EPA 200.8
{, ,
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

err Chain of Custody Record (COC)
\ MERITECH, INC.
ENVIRONMENTAL LABORATORIES
_} \N 642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritechlabs.com
Sampling Dates & Times
Sample Location and/or ID # St
Client: rgbC -rral-,-gym Phone:_(815) 235-2,y43
Address:_')aI E. rYlc6r-) St Fax: 1 6) 335-4{p-la
0.teimblG�fChry mh2m•Cah-)
FrCfl '�+ Email: mca.ter@Pasch �Uber ram
—Dolc'a-� LEI Project:ggtf h Aubber(
Attention: Rrnw'1nh0b1Pt
How would you like your report sent?
Circle all that apply: Email breferred), Fax, Mail
Person Taking Sample (Sign/Print):
art
End
Comp?
#of
Date
Time
Date
Time
Grab?
I Cont.
I!-3 rry
!•'tis'Pr>7
li-S-i7
So Fro
(�
114-17?:u+F"i
Method of I
UPS
Fed Ex Are these results for
Hand Delivery Relinquished by:r� /
Other Relin " I by:
i
elinquished by:
urposes? Yes [A] No ❑
Date: Time: �J
i
Test(s) Required
done
S
In: mg/L
I9
Turn Around Time'
`RUSH work needs prior approval.
Lab Use Only
On Ice? pH OK?
Yes / No Cl OK?
nure Upon
Isltor #
Ijug #
mg/kg ❑ ug/L ❑
ate/ 7 Ti
SO
Time:

r
MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit:http;J/ooital.nc'denr:ofg]/wq/w/yy/np�essw#tab-4
Permit No.: hl/l;/a/-f1/- j/.Q/3./Z/ 5/ or Certificate of Coverage No.:
Facility Name: Patch Rubber Company _-
County: Halifax- Phone No. 252-536-2574
Inspector: 2L o C Ar'-It
Date of Inspection. //•-'y ` 21917
Time of Inspection: // V5 P1 - - - --
Total Event Precipitation (inches):_<-f
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement -Please refer to these definitions, if applicable.
A "representative storm event' is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee' or Designee)
Pagel of 2
SWU-242, LaS[modifled 10/25/2012

1
--.�..—�_q:...--Outfal}Description:•--------•----•=-•_----�_____�_..:_,_::_`._. _—��_
Outfall No. 001 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to -Roanoke River—,_ _— -
Describe the industrial activities that occur within the outfall drainage area:
North -parking lot, roof drains_, _
2. • Color: Describe die color. of the charge using basic colors (red, brown, blue, etc) and tint
(light, medium, dark) as descriptors: WL
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): iVuti��
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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 1 is no solids and 5 is extremely muddy:
p2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
No
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall?
Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe -
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
SWU-242, Last modified 10/25/2012
Page 2 of 2

A R
MC®ENR.
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfillingout thisforn,please visit- httjj,W1jkjtal.ncdiF&,bre/well/Wv— mQnf/riOessw#66=4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Hal
Inspector:.
Date of Inspect
Time of Inspec
Total Event Precipitation (inches): D a
No.--252-5367-2574
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
[� Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a 'representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to 6e
performed during a "representative storm event" or during a "measureable storm event" However,
I, some permits do not have this requirement Please refer to these definitions, if applicable. �.
€. A `representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
i and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than +,
fi 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
I precipitation.
II A "measurable storm event" is a storm event that results in an actual discharge from the l
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 DWQ Regional Office.
By this "signatures I certify that this report is accurate and complete to the best of my knowledge:
or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

I
1. Outfall Description:
Outfall No. _ 002 Structure (pipe, ditch, etc.) - Concrete pipe _
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area: -.
Roof drains
2. Color: Describe the color of
(light, medium, dark) as descriptors:
3. Odor. Describe any
weak chlorine odor, etc.):'
using basic colors (red, brown, blue, etc) and tint
that the discharge may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: Q
2 3 4 5
S. 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:
O 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. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
SWU-24Z Last modified 10/25/2012
Page 2 of 2

�*mv t-nain oT LUstody Record (CCIC)
i
NPDES#: NC.S]C 3a5
Client: Fehr C_yatyj -; Phone: (8151 c135 ,7(�4L3
I1fI E R ITE C H, INC.
Address: ) E. mdirl Fax:z_q& a35-4(n'.,ra
ENVIRONMENTAL LABORATORIES
. Ote;nnoo Efchr .grata ».co
1 Email:
rn terC prtkti nbBr tarn
642 Tamco Rc. Phone: [phone]
�jt�f�-: i -
P,rojectiAit'GYi Atjibt eryl
Reidsville NC 27320 Fax: [phone]
,
Email: [e-mail]
Attention: :T Turn Around Time*
www.meritechlabs.com
How would you like your report sent? 'RUSH work needs prior approval.
Circle all that apply: mal referred), Fax, Mail Std 110da s) 3-5`Da s 24-e8Hm
SamPIingDates &Times
Per Son TakingSample(Sign/Print):
Sample Location and/or ID #
i , Lab Use Only
Start End
Date Time Date Time
COMP? #ofOn Ice? pH OK?
Grab? Cot. Tests) Required
Yes
es/N
No Cl OK?
-
t�F
!.pment.
thod of "• De-hlorinatlon I
Comments:
UPS
Fed Ex Are these results for
❑ Hand Delivery Resnquiihed by:,tng,1w
IIX] Other IRelinquiskedby:
urposes? Yes M No ❑
Date:: jrb r%n ,;,Time
ZJug#
os(tor fl_ _
EJ
Date: Time:

F E H R GR�:NA
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7016 0750 0000 0684 3111
Return Receipt Requested
October 6, 2017
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - September 2017
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for September 2017.
® Please note the following:
m
0
The facility was not able to collect the required samples from a "Representative
v
Storm Event" for the month of September 2017.
a
m
The facility wilt continue monthly collection of storm water samples for analysis
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Amy L. Trimble, CHMM
Environmental Scientist
ALT: m ll Q�R BCTOFS/
Enclosure N
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\17.105\Final\ALT 17-105 - Storm Water SDO September 2017 Cover Letter.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www•fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(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 Halifax
PIIONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PACE 2.
----------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TP1I
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
mg/1
mg/1
writ
aVmo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of 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. Rased 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) (Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of September 2017. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

FEHRGFLA"'�M
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7016 0750 0000 0684 3234
Return Receipt Requested RECEIVED
November 13, 2017 NOV 2 S 2011
Division of Water Quality CENTRAL FILES
Attention: Central Files DWR SECTION
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - October 2017
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for October 2017.
® Please note the following:
m
0
• The facility was not able to collect the required samples from a "Representative
v Storm Event" for the month of October 2017.
m
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
a/md �/l tlYi l� 1L
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\17-105\Final\ALT 17-105 - Storm Water SDO October 2017 Cover Letter.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 I p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber CompanV
PERSON COLLECTINGSAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(This monitoring report shall be received by the Division no later that 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERmrrTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
----------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part R: Vehicle Maintenance Activitv Monitorine Reouirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&Grl'PH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/vr
MG
inches
m /I
mg/1
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of 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. 1 am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
/Y �oi7
(Signature of Permitte (Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of October 2017. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

501
FEHRGRt W-1111
' ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7016 3560 0000 7730 5068
Return Receipt Requested
August 11, 2017
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
AUG 17 Z017
CENTRAL FILES
DWR SECTION
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - July 2017
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for July 2017.
Please note the following:
• Storm water samples were collected during a representative storm event on
July 28, 2017.
• The results for zinc are above the facility's permit benchmark for Outfalt 001 N
and Outfalls 002 S.
• The facility has already implemented its Tier 2 response, and will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
'Tni:ti��yCs�
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\17-105\Finat\ALT 17-105 -Storm Water SDO July 2017 Cover Letters.dooc
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCIIARGE OUTFALL
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber CompanV
PERSON COLLECTING SAMPLE(S) Marlo Cart .
CERTIFIEDLABORATORY(S) pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(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.)
Ty Halifax
ENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
buttalf
No.
Date
Sample
Collected
Total
Rainfall
---
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per mol th? _ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorine Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
005A;
__
e'00400
Total Flow
(if applicable)
Total
Rainfall
"Qdg&:Grease
(ifappl:)
Non -polar
O&G/TPll "tSitspeti'i,
(Method 1664 z
SGT-hIEM), if
nt I.
dotal
o11 ds
`
din"1
pll'
NeNv (Motor
Oil Usage
mo/dd/vr
1vIG
inches
In /I
-
unit
of/nto
Form SWU-247, last revised 21212012
Page 1 of 2

s,rORNI EVENT CIIARAcrERls,rics:
Date 07/28/2017
'1'olal livent Precipitation (inches): 0.29
Event Duration (hours): (only if applicable —see permit.)
(if more than one stonn event was sampled)
Date
'total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see pennit.)
"I certify, under penalty i aw, that this document and all attachments were prepared under
system designed t/ility
as althat qualified personnel properly gather and evaluate the infornmti
or persons vvho to
he system, or those persons directly responsible for gathering the inf
best of nq knowlebelief, true, accurate, and complete. I am aware that there are sign
including the p� ssf fines and imprisonment for knowing violations."
of Pennittee)
(Date)
Mail Original :und one copy to:
Division of Water Quality
Attn: Central riles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
direction or supervision in accordance with a
submitted. Based on any inquiry of the person
nation, the information submitted is, to the
,ant penalties for submitting false information,
Conn SWU-247, last revived 21212012
Page 2 or 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Brian Paluzzi
Client: Fehr Graham
220 Prairie St, Suite 208
Rockford, IL 61107
Meritech Work Order #
07311742 Sample:
OF 001 N Grab
Parameters
Results
Analysis Date
COD
21.0 mg/L
8/1/17
Zinc, total
0.728 mg/L
8/3/17
Meritech Work Order #
07311743 Sample:
OF 002 S Grab
Parameters
Results
Analysis Date
COD
24.0 mg/L
8/1/17
Zinc, total
0.200 mg/L
8/3/17
Report Date:
8/8/2017
NPDES #:
NCS000325
Project:
Patch Rubber Co.
Date Sample Rcvd:
7/31/2017
7/28/17
Reporting Limit Method
15 mg/L EPA 410.4
0.010 mg/L EPA 200.8
7/28/17
Reporting Limit Method
15 mg/L EPA 410.4
0.010 mg/L EPA 200.8
I hereby certify that I have reviewed and approve these data. 4.
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
t e l . (33 6) 3 42-4748'f a x. [phone]

Chain of Custody Record (COC)
NPDES#:A(LS QM3a5
I!/IE�tli"ECH INC,
Client: FehY rrnr,,m
Phone:(S/5ia35-7Co4�3
a�
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
a,s Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
Address:..@al E. rr)o: r
-6=Pa+l Z . (nIUaa
�t�l��i"= iCfD
Attention: M T
Fax:35-44o-"a
0.+r,mbla�fchw�mev'-n.cert-t
Email:mcarfer@eLth bber. turn '
Project:PatU'7 Piubber l' n r
P.O.#:
Turn Around Time•
www.meritechlabs.com
Sampling Dates & Times
Sample Location and/or ID ItStart End
Date Time Date Time
r— 7,��1 yr3c>pK- -7-;2�-r7 %3sp41
How would you like your report sent? 'RUSH work needs prior approval.
Circle all that a I Email referred), Fax, Mail St d )Oda s) 3-5 Davz ��r
apply:
Person Taking Sample (Sign/Print): Lab Use Only
Comp?
Grab?
G
not
Cont.
Test(s) Required
0 Ice?
es No
pH OK?
Cl-OK?
OF co
- /�
y 3� �w,
-17
V,V3
T
a
L
Temperature Upon
o-
Method of
Shipment:
" Dechlorinatlon <0.5 m) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field prior
to reservation.
Receila
S �2
Comments:
Compositor#
❑ UPS
Fed Ex
❑ Hand Delivery
Other
Are these results for regulatory purposes? Yes CK
Relinquished by: , c/ Date: Tme:
/%%ljRh:�(.!,!)vr6—3%'�
Rel' u e b � te: /� Time:
Relinquished by: Date: Time:
No ❑ Report results
Reiv by: i
/.'rJ/a'M _'
_/ Received by:
ReceKed by3
Jug #
in: mg/L � mg/kg ❑ ug/I ❑
ate: Time:
Date: Time:
Pat; Ti

AlkTMW
RC® SIR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform, please visit: http;//portalncdenrory;Jwe Jwq/Ws/sti/npdcccevnt h-e
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: A9tA42M CJrzc
Date of Inspection: -1
Time of Inspection: 1-i : 35 r, rr.
Total Event Precipitation (inches): O.2qP J0 .5
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
,►!1MOV.
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
! Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
I performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
i and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DW(
Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North parking lot, roof drains
2. Color. Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: to of\G
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): tJone
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater-discharge, where 1-is no solids and 5 2 the surface covered with -Floating solids:
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:
V 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? 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 madifled 10/25/2012

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance onfilling outthisform, please visit: htW;lJ pnrtal.ncdenr.org/wrb/wq/ws/sti/np(lecswfttah-4
Permit No.: h[/jC/g/- /-a/_-Q/3/2./ 5/ or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: _PN!z51C\\&—k CC-`6
Date of Inspection:
Time of Inspection: tA• y3 5�m
Total Event Precipitation (inches): 0.2q" P i\ " " 5
Was this a "Representative Storm Event" or "Measureable Storm Event' as defined by the permit?
(See information below.)
4 Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or ineasureable storm event' (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event' or during a "measureable storm event" However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature, 1 certify that this report is accurate and complete to the best of my knowledge:
(Sid nature 9(Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.) _Concrete pipe
Receiving Stream:_ Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
Roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc) and tint
(light, medium, dark) as descriptors: tS ore -
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): gore'_
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where l is no solids and 5 is the surface covered with floating solids:
1Q 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. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes N�
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 madffled 10/25/2 D12

STORDINATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325---
FACILITYN.AME Patch Rubber Company
PERSONCOLLECTING SAMPLE(S) Mario Car
CERTIFIEDLABORATORY(S) Paces, Analytical Lab#40_
Lath #
Part A: Specific Monitoring Requirements
SEP 18 2017
!V aRMAT/ VPROCESSINGWjV
SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(This monitoring report shall he received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY- Halifax
PHONENO. 252)536-2574
SIGNATURE OF PERMITTER OR DESIGNEE
REOUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month^ _yes X no
(ifycs, complete fart B)
Part B: Vehicle Maintenance Activitv'h1nnitoriue-Requrements
Outfall
No.
Date ;
Sample
Collected
50050
"00556
00530' :
00400
Total Flow
(if applicable) i
Total
!Rainfall
'Oil &'Grease
if appl.)
. �
Non-polar,
O&GIrpil—, I
(\Iellinil 1664`;'Soli<Isl.
SGT-IIE111)� Ifi
n L.
1b611, -•;,
SaSocr pled :
;
,t .c
p11
New Motor
Oil Usage
mo/dd/vr
MG
inches.
�m
-
rug/1 -'
unit__
.gaVmo
i
i
Form SW II-247, lrut revised 21220J2
Page I of 2

STOP. EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date 08/08/2017 Arm: Central Files
Total Event Precipitation (inches): 0.11 1617 Mail Service Center
Invent Duration(Ironrs): (only if applicable — see permit.) Raleigh, North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only it applicable — see permit.)
"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�that qualified personnel properly gather and evaluate the information submitted. Based on my Inquiry of the person
or persons who n e the system, or those persons directly responsible for gathering the Information, the information submitted is, to the
best of my kn e•Ier „c and belief, true, accurate, and complete. I am swore that there are significant penalties for submitting false Information,
including tl po ability of fines and imprisonment for knowing violations."
O•y i /7
(SS6umure of rmi(tee) (Date)
Form SWU-247, last revised 22R012
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Brian Paluzzi
Client: Fehr Graham
220 Prairie St, Suite 208
Rockford, IL 61107
Report Date: 8/17/2017
NPDES #: NCS000325
Project: Patch Rubber Co.
Date Sample Rcvd: 8/8/2017
Meritech Work Order #
080817130 Sample:
OF 001 N Grab
8/8/17
Parameters
Results
Analysis Date Reporting Limit
Method
COD
<15 mg/L
8/10/17 15 mg/L
EPA 410.4
Zinc, total
0.331 mg/L
8/14/17 0.010 mg/L
EPA 200.8
Meritech Work Order #
080817131 Sample:
OF 002 S Grab
8/8/17
Parameters
Results
Analysis Date Reporting Limit
Method
COD
17.0 mg/L
8/10/17 15 mg/L
EPA 410.4
Zinc, total
0.133 mg/L
8/14/17 0.010 mg/L
EPA 200.8
I hereby certify that I have reviewed and approve these data.
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

59IM Chain of Custody Record (COC)
MEROTECH, INC.
ENVIRONMENTAL LABORATORIES
t
642 Tamco Rd. Phone: [phone]
a '
Reidsville NC 27320 Fax: [phone]
Email: info@merite(hlabs.com
www.meritechlabs.com
Sampling Dates & Times
Sample Location and/or ID # Start
End
Date : Time I Date I Time
p! [ r rj
s 5 �
N PDES#:_A C S oa-)3a5
Phone: (e15)a35-7o43
Fax:_(Ql5) a35-44(D-�al
0.trimbie-002{$hr- mdh .con-)
Email: rn- fer@PQ�y �bber ram.
Project:ATCh A bber(
P.O:#:
Attention: HmliriMbiuTurn Around Time
HOW Would you like your report sent? 'RUSH work needs prior approval.
Circle all that apply: Email referred), Fax, Mail Std 10 days) 3 s oays 24—a8 Rrrr
Person Taking Sample(Sign/Print): ��
} Lab Use Only
Comp? it of Test(s) Required Yes
pH K?
Grab? Cont. Yes / No Cl OK?
C� 13c.
a 7_n. (^.r)r) }
y
Temperature Upon
Method Of
-'*Dechlorination <0.5 y
( ppm) of Ammonia, cyanide, Phenol and TKN samples must be done in the field prlor.to
preservation. '"*
Receipt: C
Shipment:
Comments:
Compositor#
❑ UPS
ElJug
Fed Ex
❑
Are these results for regulatory purposes?
Relinquished 6
Yes IX No ❑
Report results in:
mg/L �a m k
g/ g
#
❑ ug/L ❑
Hand Delivery
DQ
Date:fr �y7 Time:/O, 5-yfu+
Kelm
Kelm ISh d
Receiv y:
'—�•
rD
"ram"
rmo
Other
b : /
�`� G—C _Dp�:
b J ?
Tim . ,7�
1
Received
Date:
.C'S
Time:
i
Relinquish 'by: Date:
Time:'Received
hill ah:
ta.` In

WDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform, please visit http,//portal.ncdeni.oro/web/m�q/ fsq/npdesswktah_4
Permit No.: LV/S/g/Q/Q/ Q/3/2/ 5/ or Certificate of Coverage No.:
Facility Name_: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: 4Zd/!
Date of Inspection:
Time of Inspection:
—F 2m/7
Total Event Precipitation (inches): Q, / I T14 • 71 3�
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
X Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfali. 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 DWQ Regional Office.
By this signature j certify that this report is accurate and complete to the best of my knowledge:
or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc.) -. Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North parking lot, roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: ; L'LGG2 . /yfo _Cs�ic
3. Odor: Describe any
weak chlorine odor, etc.): _
odors that the discharge may have (Le., smells strongly of oil,
_ 4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with Floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

r
KDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forgutdonceonfilling out thisform,please visit: hUll,/lportalncdenror`/webwvn/ws/su/nVdessw#tab-a
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector:�NaL
Date of Inspection:.
Time of Inspection:
/7
Total Event Precipitation (inches): (9 • / I ?' 1 : (• `
Was this a 'Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
K Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be f
performed during a "representative storm event" or during a "measureable storm event" However, 1
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm eveni that measures greater than 0.1 inches of rainfall l
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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
i interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signature, I cerq�y that this report is accurate and complete to the best of my knowledge:
of Per iittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
outfallNo. 002 -. _ Structure (pipe, ditch, etc.) Concrete pipe Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
Roof drains
2. Color: Describe the color of the discharge u ino, basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L' LG�R o &Cdt
3. Odor: Describe any
weak chlorine odor, etc.): _
odors that the discharge may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
O 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 1 is no solids and 5 is extremely muddy:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes o
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
S4W-242, Last modified 10/25/2012

t.rtdrrt oT t-ustody Record (COC)
MERIT'ECH, 9NCa
\ ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
A.�
Email: [e-mail]
www.meritechlabs.com
Sample Location and/or ID #
Method of
Shipment:
] UPS
] Fed Ex
Hand Deliver
T Other
Are these
Sampling Dates & Times
Start End
Date � Time Date Time
y �n-)
Address:_161 E, u• it
NOW Would you
Circle all that apply:
Taking Sample (Sign/Pr
ses? Yes 14 No ❑
Time:/O: Sy
Date: Time:
NPDES#: NCS
Phone: (8>510135-7La43
Fax:120 aw-4,lo-ga
0.trirnbie:@ fy-.gmI22m.con
Email: mcariece�etth�m
Project:l 2kb Rubbe—r a =
P.O.#:
your report sent?
IDpreferred), Fax, Mall
Co�r. Test(s) Required
ort results in:
G��1
Turn Amend Time
•RUSH work needs prior appn
d 10 days) 13 - 5 Da" I�a
Lab Use Or
On Ice? pH
Yes / No ClI
D Temperature ui
Receipt:
Compositor 1
Jug #
I mg/kg ❑ ug/L ❑
�
is
Date: Time;

r
LVI
FEHR GRAks-1AN!
ENGINEERING & ENVIRONMENTAL
Certified Mail No. 7016 0750 0000 0684 2886
Return Receipt Requested
July 12, 2017
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
(SDO) Monitoring Report - June 2017
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for June 2017.
Please note the following:
The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of June 2017.
The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
a-I-YUd .Tai"u-C)
Amy L. Trimble, CHMM
Environmental Scientist
ALT: m 11
Enclosure
cc: Marto Carter, Patch Rubber Company
0APatch Rubber Company\17-105\Final\ALT 17-105 - Storm Water SDO June 2017 Cover Letter.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www,fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(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 Halifax
PHONE NO. 2( 521536-2574
--]
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorine Reouirements
Outfall
No.
Date
Sample .
Collected
50050
00556 .. '
00530'
00400'
Total Flow
(if applicable)
Total -
Rainfall
Oil& Grease
(if appl.)
Non -polar
O&G/TP1I
(Method 1664
SGT-ITEM), it
Total
Suspended ',
Solids
plI
New Motor •.
Oil Usage.
:x
mo/dd/vrr
MG
inches
in
In/1
unit
al/nro
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, tinder penalty law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assu a that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manatle the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowle a and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the poWbility of fines and imprisonment for knowing violations."
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of June 2017. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

n
�C3
FEHRGR�:�,'�M
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7016 0750 0000 0684 2671
Return Receipt Requested
June 13, 2017 RECEIVED
JUN 2 0 7p17
Division of Water Quality CENTRAL FILES
Attention: Central Files DWR SECTION
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - May 2017
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for May 2017.
Please note the following:
• Storm water samples were collected during a representative storm event on
May 22, 2017.
• The results for zinc are above the facility's permit benchmark for Outfall 001 N
and Outfalls 002 S.
• The facility has already implemented its Tier 2 response, and Will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
a-md -T.;j-rM0-Y--)
Amy L. Trimble, CHMM
Environmental Scientist
ALT:mII
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\17-105\Fina1\ALT 17-105 - Storm Water SDO May 2017 Cover Letters.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAM PLE(S) Marjo Carter
CERTIBIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(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 Halifax
PIIONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Date
I Sample
Collected
----------
----------
----------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorine Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/fPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
PH
New Motor
Oil Usage
mo/dd/vr
MG
inches
m /l
m /1
unit
al/mo
Form SW U-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 05/22/2017
Total Event Precipitation (inches): 0.07
Event Duration (hours): (only if applicable- see permit)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable - see permit.)
Mail Original and one copy to:
Division of 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 qua ned personnel properly gather and evaluate the information submitted. Rased on my inquiry of the person
or persons who manage the syst n, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and bell , true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of f(es and imprisonment for knowing violations."
Permiltee)
6/1YI17
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
a _
Laboratory Certification No.165
Contact: Brian Paluzzi Report Date: 5/31/2017
Client: Fehr Graham NPDES #: NCS000325
220 Prairie St, Suite 208 Project: Patch Rubber Co.
Rockford, IL 61107 Date Sample Rcvd: 5/23/2017
Meritech Work Order # 052317103 Sample: OF 001 N Grab 5/22/17
Parameters
Results
Analysis Date
Reporting Limit
Method
COD
43 mg/L
5/25/17
15 mg/L
EPA 410.4
Zinc, total
0.816 mg/L
5/25/17
0.005 mg/L.
EPA 200.8
Meritech Work Order # 052817104 Sample: OF 002 S Grab
Parameters
Results Analysis Date
5/22/17
Reporting Limit Method
COD
31 mg/L
5/25/17
15 mg/L
EPA 410.4
Zinc, total
0.120 mg/L
S/25/17
0.005 mg/L
EPA 200.8
t hereby certify that t have reviewed and approve these data. (t .
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

' rtrxpa,9+4s.rna
�Secftn A Sec.:.._ e
CHAIN -OF -CUSTODY I Analytical Request Document
The Chuonat-Custody Is a LEGAL DOCUMENT. All retevant fields must be completed aecurstely.
—Repon
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����r
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: gip;//nortaI.ncdenr.org/web/wq/ws/stt/nndecsw#tah-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: 4iHt CUAIV _
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): 6,07
,?N.. 6.00
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to he
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature, I certifyAi. t this report is accurate and complete to the best of my knowledge:
or Designee)
Page 1 of 2
SWU-242, Last modified 10/2512012

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke .River
Describe the industrial activities that occur within the outfall drainage area:
North oarkino_lot, -roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: t-A \ A
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): tN X A
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
lO 2 3 4 5
S. 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 1 is no solids and 5 is extremely muddy:
l._� 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
B. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe t-1 VN
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 10/25/2012

NCR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance onfilling out thisform, please visit.- http,//portalocdenr.org/web/wq/wc/si npdesiw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: zz fto CmTe
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): 0,1 07
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by -the permit?
(See information below.)
[jA Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm even( that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
1.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
i A "measurable storm event" is a storm event that results in an actual discharge from the i
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
1 interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signature, I certifyjpt this report is accurate and complete to the best of my knowledge:
Lure of Permiitee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River -
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the,discharge usin,g basic colors (red, brown blue, etc.) and tint
(light, medium, dark) as descriptors: CtLA2 ^ No �'�<<� at Tt
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): Alow
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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:
O2 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:
6 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
B. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes d%
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 Z
SWU-242, Last modified 10/25/2012

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(This monitoring report shall be received by the Division no later than 30 days from
RIF /�etD to the facility receives the sampling results from the laboratory.)
2017
FACILITYNAME Patch Rubber Company V SVCOUNTY Halifax
PERSON COLLECTING SAMPLE(S) Not applicable MAY 1 PIIONE NO. 2( 52 )536-2574
CERTIFIED LABORATORY(S) Lab # FILES
Lan it SECTION
SIGNATURE OF PERDIITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes Xno
(if yes, complete Part B)
Part R: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-HEM), if
qppl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/vr
MG
inches
mo/I
m
unit
al/mo
Form SWU-247, lost revised 21212012
Page 1 of 2

STORM EVENT a lARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable —see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under Fnnity of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system design[ o assure that qualified personnel properly gatber and evaluate the Information submitted. Based on my inquiry of the person
or persons w manage the system, or those persons directly responsible for gathering the Information, the Information submitted Is, to the
best of myAllowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
inciudin ; tc possibility of fines and imprisonment for knowing violations."
/jfl, s 117
of
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of April 2017. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

lVJ
FEHRGRL:n,'�M
ENGINEERING & ENVIRONMENTAL
Certified Mail No. 7016 0750 0000 0684 1216
Return Receipt Requested
March 7, 2017
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - February 2017
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for February 2017.
Please note the following:
Storm water samples were collected during a representative storm event on
February 15, 2017.
The results for zinc are above the facility's permit benchmark for Outfall 001 N.
The facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
a -r"OU-)
Amy L. rimble, CHMM
Environmental Scientist
ALT:dld
Enclosure
cc: Marto Carter, Patch Rubber Company
0APatch Rubber Company\77-105\Final\ALT 17-105 Storm Water SDO February 2017 Cover Letters.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(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.)
FACILTTYNAME Patch Rubber Company COUNTY Halifax
PERSON COLLECTINGSAMPLE(S) Not applicable ""�CEIVED PHONE NO. 2( 52)536-2574
CERTIFIED LABORATORY(S) Lab #
Lab # Apt 2 4 201:
SIGNATURE OF PERMITTEE OR DESIGNEE
Par[ A: Specific Monitoring Requirements CENTRAL FILES REOUIRED ON PACE 2.DWR SECTION
Outfall1
II I
-------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-IIEM), if
appl.
'Total
Suspended
Solids
PH
New Motor
Oil Usage
mo/dd/ r
MG
inches
mg/1
m I
unit
goUmo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of 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 assur that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who mansgg the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledgefand belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the possibjlity of fines and imprisonment for knowing violations."
tee)
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of March 2017. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

M
km
FEHRGR�:"J
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7016 0600 0000 2052 4238
Return Receipt Requested
April 11, 2017
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
(SDO) Monitoring Report - March 2017
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for March 2017.
Please note the following:
The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of March 2017.
The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
a—.d --r. ufmak)
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\17-105\Final\ALT 17-105 - Stor n Water SDO March 2017 Cover Letter.docc
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATFR DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Marjo oCarter
CERTIFIEDLARORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(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 Halifax
PIIONENO. 2f 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REOUIRFD ON PAGE. 2.
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part 6: Vehicle Maintenance Activity Monitorine Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/rPll
(Method 1664
SGT-ITEM), if
appl.
Total
Suspended
Solids
p1I
New Motor
Oil Usage
mo/dd/ yr
MG
inches
m I
m /I
unit
al/mo
Form SWU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date 02/15/2017
Total Event Precipitation (inches): 0.10
Event Duration (hours): (only if applicable— see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Piles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 certify, under pena� asv, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to n�sur hat qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage he system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my know �dge nd belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the p�sib' ty of fines and imprisonment for knowing violations."
of Permittee)
317 /7
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
p
Contact: Amy Trimble
Report Date:
2/27/2017
Client: Fehr Graham
NPDES#:
NCS000325
221 E. Main St.
Project:
Patch Rubber Co.
Freeport, IL 61032
Date Sample Rcvd:
2/16/2017
Meritech Work Order #
021617130 Sample:
OF 001 N Grab
2/15/17
Parameters
Results
Analysis Date
ReportingLimit
Method
COD
<15 mg/L
2/23/17
15 mg/L
EPA 410.4
Zinc, total
0.413 mg/L
2/21/17
0.005 mg/L
EPA 200.8
Meritech Work Order #
021617131 Sample:
OF 002 S Grab
2/15/17
Parameters
COD
Zinc, total
Results Analysis Date
<15 mg/L 2/23/17
0.061 mg/L 2/21/17
Reporting Limit Method
15 mg/L EPA 410.4
0.005 mg/L EPA 200.8
1 hereby certify that 1 have reviewed and approve these data. & _
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

f SI=
Chain of Custody Record (COC)
NPDES#:_ NC..5 0003a5
MERITECH; ONCE
Client: F@b( -rrnrv+m
Phone: d8151a35-7(o43
A \
Address:ffil E. n-&r-) St'
Fax:1815i a35-4{033
ENVIRONMENTAL LABORATORIES
—17 con2x
atrimbleGfchr-�qra#V77 ml
Email:
lia
_c�
mcarter@Pafthrc r-, r irYl
'
642TamcoRd. Phone: [phone]
P%CPi': ICf7
Project:PiCFCh Aubber('QngWn)V
Reidsville NC 27320 Fax: [phone]
P O #:
Email: [e-mail]
Attention: rri T
Turn Around Time -
www.meritechlabs.com
How would you like your report sent? 'RUSH work needs prior approval
Circle all that apply: Email referred), Fax, Mail Std 10da s) 3-5 Das Z
Sampling Dates&Times
Person ple(Sign/Print):
Sample Location and/or ID #
Lab—UjSe0111y
Coca
Comp?
?
#of
Tests)
Required
P HOK
Start End
Date Time
Date Time
Grab?
Cont.
yes / No
CI Or-
F
2kv5k%-'
10:25T
Z`vskn
%0: SzG^
�•
t L`
OF coa
3
Temperature upon
Method of
*: Dechlorination (<0.5 pm) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field
Receipt:
riorto preservation.
Shipment:
Comments:
Compositor#
❑ UPS
El Fed Ex
Are these results for regulatory purposes? Yes Q
Relinquished
Jug #
No ❑ Report results in: mg/L mg/kg ❑ ug/L ❑
Hand Delivery
by: Date:
�- � 1b r1 Tme:
eceived b
Rll:3gq
� e: Tme• 3
Other
Relinquished Time:
�S R elved by: !+""
/�
Date: Time:
i �
Reli qulshed by: Date: Time:
RecedbY Lab:
•� r�

4
r
NC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform, please visit: littp�//portal.ncdeiir.Qrg/web/wq/ws/­su/iipdessw#tab-
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: 4�9h�e,, urr
Date of Inspection: Z \"
Time of IncnPrtinn- \O '.
Total Event Precipitation (inches): 0 . \ O ?N In .00
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
N Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event pleasuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
I permitted site outfall. The previous measurable storm event must have been at least 72 hours j
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 DWQ Regional Office.
By thisrsignatw'eertify�that this report is accurate and complete to the best of my knowledge:
re of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North parking lot, roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: t lone
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:
10 2 3 4 5
S. 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:
O 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:
10 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes 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 10/25/2012

'' e
MC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidonce on filling out this form, please visit: http�//12ortal.ncdenr.ol'g/web/wq/ws/su/npdes5w#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Hali-fax Phone No. 252-536-2574
Inspector: ASc
Date of Inspection:
Time ofln-spectio—
Total Event Precipitation (mches):O. \O ?H _ ko .0o
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
tA Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
j 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 DWQ Regional Office.
By this s�Uature,; ceroti that4his report is accurate and complete to the best of my knowledge:
of Peyfn-ittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: 1Aom&
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): t,1oC'e'_
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
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 1 is no solids and 5 is extremely muddy:
CD 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes Q
9. Is there evidence of erosion or deposition at the outfall? Yes 60J
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 10/25/2012

STORDIWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2017
(This monitoring report shall be received by the Division no later than 30 days front
the date the facility receives the sampling results from the laboratory.)
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
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-IIEM), if
a 1.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ yr
MG
inches
ma/I
m /1
unit
al/mo
Form SWU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 certify, under penalW of law, that this document and all attachments were prepared tinder my direction or supervision in accordance with a
sys Aire 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 foes and imprisonment for knowing violations."
i 'lv^6v/l
(Signature of Permittee) (Date)
1�
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of January 2017. "No Flow"
Form SWU=247, last revised 21212012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLF(S)_ Marjo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab#40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(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 Halifax
PHONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
'
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TP❑
(Method 1664
SGT-IIEM), if --
appl.
Total
Suspended
Solids -
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
mg/1
mg/1
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2

STORD4 ENTENT CHARACTERISTICS:
Date 12/06/2016
Total Event Precipitation (inches): 0.16
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Nlail Original and one copy to:
Division of Water Quality
Attn: Central Piles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty/paw, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to ass r that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons wbo elan d the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowlet a and belief, true, accurate, and complete. I am aware that there arc significant penalties for submitting false information,
including the pos ib' it. of lines and imprisonment for knowing violations."
Pennittee)
(Date)
Form SWU-247, last remised 21212012
Page 2 of 2

FEHR GRAN IJ�M
ENGINEERING & ENVIRONMENTAL
Certified Mail No. 7016 0750 0000 0682 9566
Return Receipt Requested
October 11, 2016
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - September 2016
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for September 2016.
Please note the following:
• Storm water samples were collected during a representative storm event on
September 1, 2016.
• The results for zinc are above the facility's permit benchmark for both outfalls.
• The facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
00
Iev
Amy L. Trimble, CHMM
m,— P
Environmental Scientist
::!-n
<
ALT:dId
O m
E1 Ji
0
Enclosures
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\16-105\Finat\ALT 16-105- Storm Water SDO September 2016 Cover Letters.docx
221 E. Main Street I Suite 200 I Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

4:
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Marl o Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2 016
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives tine sampling results from the laboratory.)
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
100556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/I'PII
(Method 1664
SGT-IIEN1), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
nno/dd/ yr
MG
inches
ma/1
m /l
unit
al/mo
Form SWU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date 09/01/2016
Total Event Precipitation (inches): 0.2
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Tiles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penal law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to a� a that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who Fibielity
a the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knmv}and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the qoof fines and imprisonment for knowing violations."
of Permittee)
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(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.)
FACILITYNAME_Patch Rubber CompanV
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitorin Requirements
Outfall -
No.
_
Date
Sample
Collected
..
50050
-
00556
.
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&CITPH
(Method 1664`,
SGT-IIEM),af
Total
Suspended
Solids
�.
pH
New Motor
Oil Usage
mo/dd/ r .
.MG
inches -
nigh
-
m
unit
gnumo
Form SWU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty aw, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to ass �e that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who mans the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledoland belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possirility of fines and imprisonment for knowing violations."
(Signature
/Y it:
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of August 2016. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

Permit Number RCS 000325
FACILITYNAME Patch RUbbe
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S)
Part A: Specific Monitoring Requirements
ATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(This monitoring report shall be received by the Division no later than 30 days from
RECEIVE11e date the facility receives the sampling results from the laboratory.)
�J COUNTy Halifax
21 2016 PHONE NO. 2( 52)536-2574
-EN RAL FILES
DWR SECTION SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more t nn 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
56
00530
00400
Total Flow
(if applicable)
Total
Rainfall
JDH & Grease
if appL)
Non -polar
O&GffPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/vr
MG
inches
94
MVA
unit
gaymo
71
Form SWU-247, last revised 21212012
Pagel of 2

STORM EVENT CHARACTERISTICS:
Date.
Total Event Precipitation (inches):
Event Duration (hours):
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches): —
Event Duration (hours): (only
"I certify, under penalty of law, that this document
system designed t "dssurc that qualified personnel 1
or persons who tri:fmge the system, or those person
best of my knos:IQdge and belief, true, accurate, am
Including thopoisibility of fines and imprisonment
of
Facility was unable to collect
the month of November 2016.
_see
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
utachments were prepared under my direction or supervision in accordance with a
gather and evaluate the Information submitted. Based on my Inquiry of the person
v responsible for gathering the information, the Information submitted is, to the
to. I am aware that there are significant penalties for submitting false information,
rin_ violations."
F:1
/ q /b
(Date)
Storm
Form SWU-247, last revised 21212012
Page 2 of 2

aceAnalytical
w pacelaDscwn
December 19, 2016
Amy Trimble
FEHR-GRAHAM &ASSOCIATES
200 Prairie Street, Suite 208
Rockford, IL 61107
RE: Project: Patch Rubber Co. 105 12/6
Pace Project No.: 92322415
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
IV
CS6 3'�)_ 6_1�
RECEIVED
JAN 19 W7
CENTAL FILES
DWR SECTION
Dear Amy Trimble:
Enclosed are the analytical results for sample(s) received by the laboratory on December 07, 2016.
The results relate only to the samples included in this report.
Analyses were performed at the Pace Analytical Services location indicated on the sample analyte
page for analysis unless otherwise footnoted.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Chris Derouen
[e-mail]
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 11

aceAnalytical
wxwpacelab&com
Project: Patch Rubber Co. 105 1216
Pace Project No.: 92322415
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Flonda/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
CERTIFICATIONS
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VrginiaNELAP Certification #: 460222
REPORT OF LABORATORY ANALYSIS
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 2 of 11

aceAnalytical e
.pacaiabcron
SAMPLE ANALYTE COUNT
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Project:
Pace Project No.:
Patch Rubber Co. 105 1216
92322415
Analytes
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
92322415001
OF 001N
EPA 200.7
SH1
1
PASI-A
SM 5220D
EWS
1
PASI-A
92322415002
OF 002 S .
EPA 200.7
SH7
1
PASI-A
SM 5220D
EWS
1
PASI-A
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 11

aceAnalytical
"wpacelah=m
ANALYTICAL RESULTS
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Project: Patch Rubber Co. 105 1216
Pace Project No.: 92322415
Sample: OF 001 N
Lab ID: 92322415001
Collected: 12/06/16 13:20
Received:
12/07/16 12:40 Matrix: Water
Parameters
Results Units
Report Limit DF
Prepared
Analyzed CAS No. Qual
200.7 MET ICP
Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Zinc
382ug/L
- 10.0 1
12/10/1600:00 12/17/1605:03 7440-66-6
5220D COD
Analytical Method: SM 5220D
Chemical Oxygen Demand
ND' mg/L
25.0 1
1211311609:30
Sample: OF 002 S
Lab lD: 92322415002
Collected: 12/06/16 13:29
Received:
12/07/16 12:40 Matrix: Water
Parameters -
Results- Units
- Report Limit DF
Prepared
Analyzed CAS No. Qual
200.7 MET ICP Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Zinc . 66.8, ug/L - 10.0 1 12/10/16 00:00 12/17/16 05:06 7440-66-6
5220D COD Analytical Method: SM 5220D
Chemical Oxygen Demand ND mg/L 25.0. 1 12113/1609:30
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/19/2016 10:11 PM without the written consent of Pace Analytical Services, LLC.
Page 4 of 11

aceAnalytical
%.pacelabs.corp
QUALITY CONTROL DATA
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Project: Patch Rubber Co. 105 12/6
Pace Project No.: 92322415
OC Batch: 340114
Analysis Method: EPA 200.7
OC Batch Method: EPA 200.7
Analysis Description: 200.7 MET
Associated Lab Samples: 92322415001, 92322415002
METHOD BLANK: 1886467
Matrix:
Water
Associated Lab Samples: 92322415001, 92322415002
Blank
Reporting
Parameter Units
Result
Limit
Analyzed
Qualifiers
Zinc ug/L
NO 10.0
12/1811622:00
LABORATORY CONTROL SAMPLE: 1886468
Spike
LCS
LCS e/ Rec
Parameter - - Units
Conc.
Result
e/ Rec Limits
Qualifiers
Zinc ug/L
500
537
107 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1886469
1886470
MS
MSD
92322383003
Spike
Spike MS
MSD MS
MSD
%Rec
Parameter Units Result
Conc.
Conc. Result
Result % Rec
% Rec
Limits
RPD Qual
Zinc ug/L 0,014
500
500 537
525 105
102
70-130
2
mg/L
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1886471
1886472
MS
MSD
92322416001
Spike
Spike MS
MSD MS
MSD
e/ Rec
Parameter Units Result
Conc.
Conc. Result
Result % Rec
% Rec
Limits
RPD Qual
Zinc ug/L ND
500
500 505
516 100
102
70-130
2
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: 12/19/2016 10:11 PM without the written consent of Pace Analytical Services, -I-C.
Page 5 of 11

0
aceAnalytical
wwwpacelabs.com
Project: Patch Rubber Co. 105 12/6
Pace Project No.: 92322415
QC Batch: 340483
QC Batch Method: SM 5220D
Associated Lab Samples: 92322415001, 92322415002
METHOD BLANK: 1888477
Associated Lab Samples: 92322415001, 92322415002
Parameter Units
Chemical Oxygen Demand mglL
LABORATORY CONTROL SAMPLE:
Parameter
1888478
Units
Chemical Oxygen Demand
mg/L
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
QUALITY CONTROL DATA
Analysis Method: SM 5220D
Analysis Description: 5220D COD
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 25.0 1211311609:30
Spike LCS LCS % Rec
Conc. Result %Rec Limits Qualifiers
750 764 102 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE:
1888479
1888480
-
MS
MSD
'
92322271001
Spike
Spike
MS
MSD
MS
MSD
%Rec
Parameter
Units
Result
Conc.
Conc.
Result
Result
%Rec
%Rec
Limits
RPD Qual
Chemical Oxygen Demand
mg/L
28.0
750
750
814
814
105
105
90-110
0
MATRIX SPIKE & MATRIX SPIKE DUPLICATE:
1888481
1888482
MS
MSD
92322733003
Spike
Spike,
MS
MSD
MS
MSD
%Rec
Parameter
Units
Result
Conc.
Conc.
Result
Result
% Rec
% Rec
Limits
RPD Qual
Chemical Oxygen Demand
mg/L
43.0
750
750
781
781
98
98
90-110
0
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 reproducer, except in full,
Dale: 12/1912016 10:11 PM without the written consent of Pace Analytical Services, L-C.
Page 6 of 11

�2ceAnalyficalo
v .pacelab&=
QUALIFIERS
Project: Patch Rubber Co. 105 1216
Pace Project No.: 92322415
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
NO - Not Detected at or above adjusted reporting limit.
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MOIL -Adjusted Method Detection Limit.
POL - Practical Quantita5on Limit.
RL - Reporting Limit.
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
S - Surrogate
1,2-Dipheny1hydrazine 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.
LABORATORIES
PASI-A Pace Analytical Services - Asheville
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Dale: 12119/2016 10:11 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 11

aceAnalytical
w vpacelah&com
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Patch Rubber Co. 105 12/6
Pace Project No.: 92322415
Pace Analytical Services, LLC
6701 Conference Drive
Raleigh, NC 27607
[phone]
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch
Analytical Method
Batch
92322415001
OF 001N
EPA200.7
340114
EPA 200.7
340516
92322415002
OF 002S
EPA200.7
340114
EPA 200.7
340516
92322415001
OF 001 N
SM 5220D
340483
92322415002
OF 002 S
SM 5220D
340483
Date: 12/19/201610:11 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 8 of 11

I
9
i
I
Document flame: I �fkg'ument Revised: Sept. 21, 20.'6
aceAnalyt cal Sample Condition U or. P,ecefpt(SC.a Ya e l of 2
Document No.: Issuing Authority:
F-W-CS-033-Rev.ol 7 Pace quality Office
Laboratory receiving samples:
Asheville Eden[] Greehwead n fa,, ra nlfl ll .
11
mullClient Name; WO# : 92322415- t
Courier: x❑Commercial ce
❑other. _ 92322415
Custody Seal Present? ❑Yes Or,-
Sealslntact? ❑Yes h'o --
Packing Material: Bubble Wrap Date/enhlalc Person E minma Contents: "
❑ P []Bubble Bags one ❑Other.'_ `
Thermometer:
IRGun ID: S•$ Z 'type of Ice: wet ❑glue .❑None ❑SamplesonimccoMgfrocesshasbegun
Cgrrectlon actorAQc.f Cooler Tamp Corrected (IC): �„ Biological Tissue Frozen? ❑Yes. QNo q'y A.
f -
Temp should be above ezing to 6'C �p _
USDA Regulated Soil (® N/A, vratersample)
�Didd �sampleess originate in a quarantine zone within the United states: CA, NY, orSC(check maps)? INdsamples odglnate 6omaforelgn source finternat0nalhi
1 I Win '
atdsMLng Hawall and Puerto Rim)?❑Yes to
Comments/Dlscre ncy:
Chain of Custod Present?
❑Yes
'o
N/A
L
Samples ArrNedwhhln Hold Time?
Yes
Nu
❑N/A
2.
Short Hold Time Ana is(Q2hr.T
Yes
No
NA
3.
Bush Tum Around Tlme Requeited?
Elyes
No
❑N/A
4.
'
Sufficient Volume?
es
❑No
N/A
S.
Correct Containers Used?
Y
[]NO
❑N/A
6.
-Pace Containers Used?
Yss
OND
❑N A'
-
Contalnermfntact?
es
No
❑NA
7.
Samples Raid Filtered?
v "
' .
A
B.11NOtediment
is visible in the dtssoWed canningSample
Labels Match COC?
i,,❑LL]rrNO
tyNa
❑N/A
9.-includes
Date/Nme/ID/Anal Matrix:,/``
t
Head space 16 VOA Vials 6S-6mm)7
Oyes
Elmo
N/A
'10.
Trip Blank Present?
❑Yes
❑no
N/A
11.
-
Trl Blank CuBody Seals Present?. -
❑Yea
QNo
CLIENT NOTIFICATION/RESOLUTION
Person Contacted:
Commend/Sample
Discrepancy:
Projea Manager SCURF Review:
Project &tanager SRF Review:
Feld DataRequhod? ❑Yes ❑No
DatelFlme:
Date: I4 j
Date:
Note: Whehever there is a discrepancy alfecth$North.Carollni'mmp]Lance -samplas, a mpyof this form will be sentto the Nonh Carolina DEHNRCertitkation Office (i.e.
Out of hdld; I11COmett praRrvattm, out of temp. Incorrect pontalners)
Page 9 of 11

t0l-
Pace..pAnaocal'Sample Condition U n Pa e 2 of 2IssoingriQuality OHlce
°Check mark top half of box if pH and/or dechlorination ProlectN is verified and within the acceptance range for VW®# 923/ E�?4 1 di
5
preservation samples.
Ph: CDl Due Date: 12/21/16
°Qnttom-half-ot-box-is to list number-of-bottes- - CLIENT: 91-FEHR
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OH Adjustment Log for Preserved Samples
Sample ID
Type of Preservative
pH upon tecelpt
Date preservation adjusted.
Time pn ;s i*n
grustad
Amount afPmenative
added
Lot
' Page 10 of 11

�C�Ar7A7y11�' /_
.mf3.fAMM
CHAIN -OF -CUSTODY / Analytical Request Document
T bW,N-O-"b. LMAL W(xA .Maawg y.
•�GL4y7Q'ni.~ya..CEAC
• • •
1
SOCU.n
®,iiYfilWri�4���,
SAMPLE 1
w;©■oG©momR.■■
.■.■■■i®■■MEN
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ems
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mom■■■Rm■�■■.
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.......a■..■...■Ro■is•.a•.
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.FIN, QO]Orw.J, iu v5)=. W7

-;A`ez; r
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform, please visit- hnp://porud.ncdencoM/web/wq/ws/su1npdessw#tah-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: C.sve
Date of Inspection: i'L U%a
Time of Inspection: 1 :ZO PrA
Total Event Precipitation (inches): 0.1 kn„
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event"(requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
i 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature. I ccyt fy thdt this report is accurate and complete to the best of my knowledge:
re of PJ!,ladittee or Designee)
Pagel of 2
SWn-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 001 _ Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream:- Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area;
North uarkino lot, roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _tAone`
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): ti o ntA
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
O 2 3 4 5
S. 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:
i� 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? Yes N�o �
8. Is there an oil sheen in the stormwater discharge? Yes pro
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguldance onfilling out thisform, please visit.- hWi;//Doi-tal.nciteiir.org/web/­wo/wi/­etj/j3l2ilgs.s3L/Ptih-,[
Permit No.: LI/&/Sf�/ 0 /4/ 3 /2/ 5/ or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector:k�11�� ryrA�
Date of Inspection: l2tto\.\'-1
Time of Inspection: 1 -%.4 P fA
Total Event Precipitation (inches): O M4l
,& ph e.Oo
Was this a "Representative Storm Event" or "Measureable Storm Event' as defined by the permit?
(See information below.)
0 Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event' is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature, I c Ptjfv that this report is accurate and complete to the best of my knowledge:
of 06ill[tee or Designee)
Page 1 of 2
5 WU-242, Last mod]ned 10/25/2012

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: tLn'ry'_
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): Non@ -
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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:
Q) 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? Yes o
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SW U-242, Last modified 10/25/2012

9 .
STORM VATER DISCIIARGE OUTFALL (SDO)
MONITORING REPORT
PermitNumber:NCS 00032
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(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 Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMiTTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
50050
Total
Flow ifa
Total
Rainfall
pH
COD
Zinc
mo/dd/ yr
MG
inches
units
mg L
mg L
001
N/A-
002
N/A
C'!C"
•t--I1/Cr%
Nov
Ulti
nin;:
_ -ICES
fuIION
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Requirements
Outfall
No.
Date
Sample
Collected
'50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GfrPll
(Method 1664
SGT-ITEM), if
appl.
'Total
Suspended
Solids
p11
New Motor
Oil Usage
mo/dd/ r
MG
inches
mg/1
mg/1
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of law at this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure tit qualified personnel properly gather and evaluate the information submitted. Rased on my inquiry of the person
or persons who manage th system, or those persons directly responsible for gathering the information, the information submitted is, to tite
best of my knowledge an belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the possibilit of fines and imprisonment for knowing violations."
(Signature of
l/ /�0/l
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of October 2016. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

I I
AlJ
0
0
0
0
a
v
m
ENGINEERING &
Certified Mail No. 7015 0640 0003 0331 5026
Return Receipt Requested
July 11, 2016
VM
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
%C:C;61V
JUL 18 Z016
WR SeCT ON
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - June 2016
Patch Rubber Company
100 Patch Rubber Road
Weldon, INC 27890
'NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for June 2016.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of June 2016.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Amy L. Trimble, CHMM
Environmental Scientist
ALT: did
Enclosures
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\16-105\Final\ALT 16-105 - Storm Water SDO June 2016 Cover Letters.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Date
sample
Collected
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?'_ yes Xno
(if yes, complete Part B)
.Part B: Vehicle Maintenance Activity' Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GPFPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pit
New Motor
Oil Usage
mo/dd/ r
MG
inches
m /l
m g/I
unit
gal/mo
Form S W U-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one stonn 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 t qualified personnel properly gather and evaluate the information submitted. Rased on my inquiry of the person
or persons who manage t system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge a belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the possibiljo of fines and imprisonment for knowing violations."
(Signature of Yermittee)
(Date)
/A4,
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of June 2016. "No Flow"
Form SWU-247, lost revised 21212012
Page 2 of 2

n
c�.
FEHR GRL'.:-:,'�l�I
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7015 0640 0003 8993 0137
Return Receipt Requested
June 10, 2016
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
RECEIVED
JUN 23 Z i�
CEN-'j' Lq FI
DWR SEC710NS
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - May 2016
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for May 2016.
Please note the following:
• Storm water samples were collected during a representative storm event on
May 17, 2016.
• The results for zinc are above the facility's permit benchmark for both outfalls.
• The facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
a 'T.�t
Amy L. Trimble, CHMM
Environmental Scientist
ALT: m 11
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\16-105\FinaIW1-T 16-105 - Storm Water SDO May 2016 Cover Letters.docx
221 E. Main Street I Suite 200 1 Freeport, It. 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results. -

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NtjtberNCS 000325 'IVCD SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
C (This monitoring report shall be received by the Division no later than 30 days from
JUN 2 3 2016 the date the facility receives the sampling results from the laboratory.)
FACILITYNAME Patch Rubber Company CENTRAI Ell E<
PERSON COLLECTING SAMPLE(S) Marjo CaWR S
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PI{ONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-ITEM), if
a il.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/vr
MG
inches
In /I
nag/1
milt
al/mo
Form S W U-247, last revised 21212012
Page I of 2

STORM EVENTCHARACTERISTICS: Mail Original and one copy to:
Date 05/17/2016 Division of Water Quality
Attn: Central Files
Total Event precipitation (inches): 0.3 1617 Mail Service Center
Event Duration (hours): (only if applicable — see permit.) Raleigh, North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches)
Event Duration (hours): (only if applicable— see permit.)
"I certify, under/dge
alty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designedsure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons wh� pe the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowand belief, true,accurate, and complete. I am aware that there are significant penalties for submitting false information,
including t10poity of fines and imprisonment for knowing violations."
of Permittee)
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

aceAna, jdical
t vpacelabs.com
May 26, 2016
n 0 S--Do 6 Z) p�
Amy Trimble
FEHR-GRAHAM & ASSOCIATES
200 Prairie Street, Suite 208
Rockford. IL 61107
RE: Project: Patch Rubber Co. 105 5117
Pace Project No.: 92298073
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
DearAmy Trimble:
Enclosed are the analytical results for sample(s) received by the laboratory on May 18, 2016. The
results relate only to the samples included in this report.
Analyses were performed at the Pace Analytical Services location indicated on the sample analyte
page for analysis unless otherwise footnoted.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Chris Derouen
[e-mail]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 1 of 10

aceAnal ,t al
w+vxpacafabsmm
Project: Patch Rubber Co. 105 5/17
Pace Project No.: 92298073
Lab ID Sample ID
92298073001 OF 001 N
92298073002 OF 002 S
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
SAMPLE ANALYTE COUNT
Method
Analysts
Analytes
Reported
Laboratory
EPA200.7
CDF
1
PASI-A
SM 5220D
WRC
1
PASI-A
EPA200.7
COF
1
PASI-A
SM 5220D
WRC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc.. Page 3 of 10

(--IlakeAnalyfical
• wmvpace/abzrom
ANALYTICAL RESULTS
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Project: Patch Rubber Co. 105 5/17
Pace Project No.: 92298073
Sample: OF 001 N Lab ID: 92298073001 Collected: 05117/16 13:05 Received: 05/18116 13:40 Matrix: Water
Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Qual
200.7 MET ICP Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Zinc 534 ug/L 10.0 1 05/23/16 18:30 05/25/16 05:47 7440-66-6
5220D COD Low Level Analytical Method: SM 5220D
Chemical Oxygen Demand NO mg/L 10.0 1 . 05/23/16 15:30
Sample: OF 002 S Lab ID: 92298073002 Collected: 05/17116 13:15 Received: 05/18/16 13:40 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
200.7 MET ICP Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Zinc 112 ug/L 10.0 1 05/23/16 18:30 05/25/16 05:50 7440-66-6
5220D COD Low Level Analytical Method: SM 5220D
Chemical Oxygen Demand ND mg/L 10.0 1 05/23/1615:30
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 05/26/2016 04:38 PM without the written consent of Pace Analytical Services, Inc.. Page 4 of 10

aceAnalytical
wxivpacelabscdm
Project: Patch Rubber Co. 105 5/17
Pace Project No.: 92298073
OC Batch: MPRP/21797
QC Batch Method: EPA 200.7
Associated Lab Samples: 92298073001, 92298073002
METHOD BLANK: 1739807
Associated Lab Samples: 92298073001, 92298073002
Parameter Units
Zinc ug/L
LABORATORY CONTROL SAMPLE: 1739808
Parameter Units
Zinc ug/L
Pace Analytical Services, Inc.
6701 Conference Dnve
Raleigh, NC 27607
[phone]
QUALITY CONTROL DATA
Analysis Method: EPA 200.7
Analysis Description: 200.7 MET
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
NO 10.0 05/25/16 04:26
Spike LCS LCS % Rec
Cone. Result %Rec Limits Qualifiers
500 448 90 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1739809 1739810
MS MSD
92298504001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Cone. Cone. Result Result %Rec %Rec Limits RPD Qual
Zinc ug/L NO 500 500 450 448 90 89 70-130 1
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1739811 1739812
MS MSD
92298554001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Cone. Cone. Result Result e/ Rae %Rec Limits RPD Qua]
Zinc ug/L 132 500 500 592 609 92 95 70-130 3
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,
Dale: 05/26/2016 04:38 PM without the written consent of Pace Analytical Services, Inc..
Page 5 of 10

(-.Illace Analytical
wmw pacelabs.cnrn
Project: Patch Rubber Co. 105 5117
Pace Project No.: 92298073
QC Batch: WETA/27699
QC Batch Method: SM 5220D
Associated Lab Samples: 92298073001, 92298073002
METHOD BLANK: 1739212
Associated Lab Samples: 92298073001, 92298073002
Parameter Units
Chemical Oxygen Demand mg/L
LABORATORY CONTROL SAMPLE:
1739213
Parameter
Units
Chemical Oxygen Demand
mg/L
QUALITY CONTROL DATA
Analysis Method:
Analysis Description:
Matrix: Water
SM 5220D
5220D COD, Low Level
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Blank Reporting
Result Limit Analyzed Qualifiers
ND 10.0 05/23/1615:30
Spike LCS LCS % Rec
Conc. Result e/ Rec Limits Qualifiers
75 74.0 99 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1739214 1739215
MS MSD
92297427001 Spike Spike MS MSD MS MSD % Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chemical Oxygen Demand mg/L 56.0 300 300 396 396 113 113 90-110 0 Mt
Results presented on this page are In the units Indicated by the 'Units' crdumn 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: 05/26/2016 04:38 PM without the written consent of Pace Analytical Services, Inc..
Page 6 of 10

aceAnalytical
wwwpacelabs.oam
QUALIFIERS
Project: Patch Rubber Co. 105 5117
Pace Project No.: 92298073
I.rxyrl�ifrfy
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
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.
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.
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, Styrene, and Vinyl chloride.
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.
LABORATORIES
PAST -A Pace Analytical Services - Asheville
ANALYTE QUALIFIERS
Mt 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: 05/26/2016 04:38 PM without the written consent of Pace Analytical Services, Inc.. Page 7 of 10

(,11a'ceAnalyfical
WWwpamfabs.=
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Patch Rubber Co. 105 5/17
Pace Project No.: 92298073
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)8344984
Lab ID Sample ID QC Batch Method OC Batch Analytical Method
92298073001
OF 001 N
EPA 200.7
MPRP/21797 EPA 200.7
92298073002
OF 002 S
EPA 200.7
MPRP/21797 EPA 200.7
92298073001
OF 001 N
SM 5220D
WETA/27699
92298073002
OF 002 S
SM 5220D
WETA/27699
Date: 05/26/2016 04:38 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Analytical
Batch
ICP/19557
ICP/19557
Page 8 of 10

vu"ument Name: Va[um2nt Hevlsea: 2bFbtl2U1b
Sample Condition Upon Recelpt(SCUR) I Page 1 of 2
� aceMalytical Document No.: I Issuing Authority:
•'. -'-coal Ilse ONI v
Project #
Client Name: WO# : 92298073
Courier; 1 Pace UP❑USPS []Client
El commercial II III I I III I II I I II III
( ❑Other:_ 92298073
Custody Seal Present? ❑yes N0 Seals Intact? ❑Yes �o
/I/JDale/Initials Person Examining Contents {' j Jb
Packing Material: J ❑Bubble Wrap ❑Bubble Bags None []Other;
Thermometer: [QIR SN: 122065387 ❑IRSN:122065371 Type of Ice: �jWet ❑Bice ❑None ❑Samples on ice, cooling process,-hy5s begun
Correction Factor. OVC Cooler Temp Corrected ('C): �, —f- Biological T-Issue Frozen? ❑Yes ❑No I[.1N/A
Temp should be,abova fr ezing to 6'C
USDA Regulated Sol[ ([dN/A, water sample)
Did sampips originate In a quarantine zone within the United States: CA, NY, or 5C (check maps)? Did samples originate from a foreign source (inter tlonatly,
r-l.,_- til.,,. Inrindine Hawaii and Puerto Rico)? FlYes I ANo
COMMENTS:
Chain of Custody Present?
Yes
❑No
❑N/A
1. '
Chain of Custody Filled Out?
Yes
0140
N/A
2. '
Chain of Custody Relinquished?
6es
ON6
[]N/A
3.
Sampler Name and/or Signature on COC?
Yes
QNo
❑N/A
4.
' Samples Arrived within Hold Time?
Yes
No
N/A
5.
Short Hold Time Analysis (02 hr)?
QYn
No
EINIA
6. '
Rush Turn Around Time Requested?
Yes
No
N/A
7.
Sufficient Volume?
Oyes
Na
CINJA
B.
Correct Containers Used?
-Pace Containers Used?
Yes
[:]No
❑No
❑N/A
❑N/A
9.
'
Containers Intact?
Yes
ONO
/A
10.
Filtered Volume Received for Dissolved Tests?
(:]Yes
❑No
N/A
11. Note if sediment is visible in the dissolved container
Sample labels Match COCi
-Includes Date/Time/IO/Anal sis Matrix:
Yes
❑No
❑N/A
12.
All containers needing acid/base preservation have been
checked?
All containers needing preservation are found to be In
compliance with EPA recommendation?
(HNOs, HzSOs, HC142; NaOH>9 Sulfide, N0OH>12 Cyanide)
Exceptions: VOA, Coliform, TOC, Oil and Grease,
DRO/8015 (water) OOC,LLHg
/
f71Yu
(7
as
7Y.,
[]NO❑N/A
❑No
rINo
❑N/A
ONIA
13. -
Samples checked for dechlorinatlon
EIN.
N/A
24.
-Headspace In VOA Vials(>5-6mm)?
Yes
❑No
❑N/a
15.
Trip Blank Present?
Trip Blank Custody Seals present?
Pace Trip Blank Lot #(ifpurchased):
❑Yes
❑Yes
❑No
❑No
❑N/A
❑N/A
16.
CLIENT NOTIFICATION/RESOLUTION
Person Contacted:
Comments/Resolutlo n:
Project Manager SCURF Review:
Project Manager SRF Review: X/ _
Note: Whenever there is a discrepancy affecting North Carolina compliance
Out of halo, incorrect preservative, out of temp, Incorrect containers)
Field Data Required? VYes UNo
Oate/Time:
Date:
Date:
copy of this form W31 be sent tothe orth Carolln

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A�
MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance onfillingout thisform,please visit: http//portal.nedmnorg/web/wq/wsjsu/aPL55w4tib-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: ffallfax Phone No. 252-536-2574
Inspector: IgRfll.o c raRT
Date of Inspection: —/7 -
Time of Inspection: 1. /S'%
Total Event Precipitation (inches): �� 3 I &. D
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
V9 Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature, I certifyt4at this report is accurate and complete to the best of my knowledge:
tune of Permit'Ke or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
Roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: 1WW
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): /+GR&
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and S is extremely muddy:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
60
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? YesU
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 10/25/2012

r
NMENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: lip://portal ncdenr org/weh/wa/ws/su /nndessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: _^4RLo CAAT914
Date of Inspection: 5'17—AV1
Time of Inspection: / 0S]p
Total Event Precipitation (inches): O- 3
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature, I certifyfllat this report is accurate and complete to the best of my knowledge:
(SiViature of Pern(ittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc.) _ Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North parking lot, roof drains
2. Color: Describe the color of the djsch`r�re using basic colors (red, brown, blue, etc) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any
weak chlorine odor, etc.): _
odors that the discharge may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
0 2 3 4 5
S. 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:
n
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. Is there any foam in the stormwater discharge? Yes /o
8. Is there an oil sheen in the stormwater discharge? Yes �Q�
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

i
FEHR GRL:N M
ENGINEERING & ENVIRONMENTAL
;r �e
ti•
Certified Mail No.: 7015 0640 0003 8992 9957
Return Receipt Requested
May 10, 2016
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - April 2016
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for April 2016.
Please note the following:
• Storm water samples were collected during a representative storm event on,,
April 2, 2016. F
• The results are below the facility's permit benchmark for each outfaU.
If you have any questions regarding these
this office.
Sincerely,
a-md *T.�;IJ-k- )
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosure
RECEI Vtj)
MAY 16 2016
CENTRAL FILES
DwR SECTION
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\16-105\FinaIW.LT 16-105 - Storrn Water SDO April 2016 Cover Letters.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME PatchRubber Company
PERSON COLLECTINGSAMPLE(S) Marlo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab#_AD__
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(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.)
I
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part R: Vehicle Maintenance Activitv Monitorine Requirements
Outfall
No.
Date
Sample
Collected
'
50050
00556
00530
004001
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(ifappl.)
Non -polar
O&G/FPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m
m &
unit
I
al/mo
I
I
I
Form S W U-247, last revised 21212012
Page 1 of 2

J
STORM EVENT CHARACTERISTICS:
Date 4/2/2016
Total Event Precipitation (inches): 0.5
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
i
I
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
I
I
I
"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 Ofure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who m age the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my know ge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the p0Xsibility of fines and imprisonment for knowing violations."
of
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

"Analytical'
.pacelabs..
April 11, 2016
h0�-0(963o_
Amy Trimble
FEHR-GRAHAM & ASSOCIATES
200 Prairie Street, Suite 208
Rockford, IL 61107
RE: Project: Patch Rubber Co 105 4/2
Pace Project No.: 92292572
Pace Analytical Services, Inc.
6701 Conference 0rrve
Raleigh, NC 27607
(919)834A984
Dear Amy Trimble:
Enclosed are the analytical results for sample(s) received by the laboratory on April 05, 2016. The
results relate only to the samples included in this report.
Analyses were performed at the Pace Analytical Services location indicated on the sample analyte
page for analysis unless otherwise footnoted.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
14-- -z;��—
Chris Derouen
[e-mail]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
wilhout the written consent of Pace Analytical Services, Inc.. Page 1 of 10

ace Analytical
/ wxwpacelabs.cam
Project: Patch Rubber Co 105 412
Pace Project No.: 92292572
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
CERTIFICATIONS
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
VrginiaNELAP Certification #: 460222
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the v ritten consent of Pace Analytical Services, Inc..
P ace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)e344984
Page 2 of 10

1 2deAnalj4icalo
.w csbbtmm
i
Project: Patch Rubber Co 105 4/2
Pace Project No.: 92292572
Lab ID Sample ID
92292572001 OF 001 N
92292572002 OF 002 S
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
SAMPLE ANALYTE COUNT
Method
Analysts
Analyses
Reported
Laboratory
EPA 2003
CDF
1
PASI-A
SM 5220D
WRC
1
PASI-A
EPA 200.7
CDF
1
PASI-A
SM 5220D
WRC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the wri9en consent of Pace Analytical Services, Inc.. Page 3 of 10

aceAnalytical
ANALYTICAL RESULTS
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Project: Patch Rubber Co 105 4/2
Pace Project No.: 92292572
Sample: OF 001 N Lab ID: 92292572001 Collected: 04/02/16 09:45 Received: 04/05/16 16:15 Matrix: Water
Parameters Results Units - Report Limit DF Prepared Analyzed CAS No.. Qual
200.7 MET ICP
Zinc
5220D COD Low Level
Chemical Oxygen Demand
Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
245 ug/L 10.0 1 04107/1618:30
Analytical Method: SM 5220D
11.0 mg/L 10.0 1
04/09/1611:33 7440-66-6
04/11/16 09:20
Sample: OF 002 S
Lab ID: 92292572002 Collected: 04/02/16 10:00 Received: 04/05/16 16:15 Matrix: Water
Parameters
Results Units Report Limit OF Prepared
Analyzed CAS No. Qual
200.7 MET ICP
Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Zinc
56.0 ug/L 10.0 1 04/07/16 18:30
04/09/16 11:36 7440-66-6
5220D COD Low Level
Analytical Method: SM 5220D
Chemical Oxygen Demand
NO mg/L 10.0 1
04/1111609:20
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Dale: 04/11/2016 10:47 PM
without the written consent of Pace Analytical Services, Inc..
Page 4 of 10

ace Analytical
/ xxvipacelabs.com
Project: Patch Rubber Co 105 412
Pace Project No.: 92292572
OC Batch: MPRP/21283
OC Batch Method: EPA 2007
Associated Lab Samples: 92292572001, 92292572002
METHOD BLANK: 1704415
Associated Lab Samples: 92292572001, 92292572002
Parameter Units
Zinc ug/L
QUALITY CONTROL DATA
Analysis Method: EPA 200.7
Analysis Description: 200.7 MET
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 10.0 04109/1610:46
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)8344984
LABORATORY CONTROL SAMPLE: 1704416
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Zinc ug/L 500 480 96 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1704417
1704418
MS
MSD
92292397001 Spike
Spike
MS
MSD
MS MSD % Rec
Parameter Units Result Conc.
Conc.
Result
Result
%Rec % Rec Limits RPD Qual
Zinc ug/L NO 500
500
450
443
89 88 70-130 1
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1704419 1704420
MS MSD
92292732001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Zinc ug/L ND 500 500 459 491 91 97 70-130 7
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit Is presented to the tight of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 04/11/2016 10:47 PM without the written consent of Pace Analytical Services, Inc..
Page 5 of 10

11�aceAnalytical
i~,whelabs.can
I
Project: Patch Rubber Cc 105 4/2
Pace Project No.: 92292572
QC Batch: WETA/27127
QC Batch Method: SM 5220D
Associated Lab Samples: 92292572001, 92292572002
METHOD BLANK: 1705580
Associated Lab Samples: 92292572001, 92292572002
Parameter Units
Chemical Oxygen Demand mg/L
QUALITY CONTROL DATA
Analysis Method: SM 5220D
Analysis Description: 5220D COD, Low Level
Matrix: Water
Blank Reporting
Result Limit Analyzed Qualifiers
ND 10.0 0411111609:20
LABORATORY CONTROL SAMPLE:
1705581
Spike
Parameter
Units Conc.
Chemical Oxygen Demand
mg/L 75
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
LCS LCS % Rec
Result % Rec Limits Qualifiers
82.0 109 90-110
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1705582
1705583
MS
MSD
92292005001 Spike
Spike
MS
MSD MS MSD % Rec
Parameter Units Result Conc.
Conc.
Result
Result % Rec % Rec Limits RPD Qua[
Chemical Oxygen Demand mg/L 64.0 300
300
420
420 119 119 90-110 0 M7
Results presented on Nis page are in the units Indicated by Me "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: 04/11/2016 10:47 PM without the written consent of Pace Analytical Services, Inc..
Page 6 of 10

acemali cal
wxwpaceFdbs.cam
QUALIFIERS
Project: Patch Rubber Co 105 4/2
Pace Project No.: 92292572
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
NO - Not Detected at or above adjusted reporting limit.
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
PQL- Practical Quantitalion Limit.
RL- Reporting Limit.
Pace Analytical Services, Inc.
6701 Conference Drrve
Raleigh, NC 27607
[phone]
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, unfounded 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, Styrene, and Vinyl chloride.
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.
LABORATORIES
PASI-A Pace Analytical Services - Asheville
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: 04/11/2016 10:47 PM without the written consent of Pace Analytical Services, Inc.. Page 7 of 10

aceMalytical
wwwpe[ehbcarn
/
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Patch Rubber Co 105 4/2
Pace Project No.: 92292572
Pace Analytical Services, Inc.
6701 Conference Dnve
Raleigh, NC 27607
[phone]
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch
Analytical Method
Batch
92292572001
OF 001N
EPA 200.7
MPRP/21283
EPA 200.7
ICP/19124
92292572002
OF 002S
EPA 2007
MPRP/21283
EPA 200.7
1CP/19124
92292572001
OF 001 N
SM 5220D
WETA/27127
92292572002
OF 002 S
SM 5220D
WETA/27127
Date: 04/11/2016 10:47 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 8 of 10

-I .— — vvcvmem herseo: 26FE82016
ditlon Upon Receipt(SCUgj Page 1 of 2
Document No.:. Issuing Authority:
IAL-CS-001-rev.05 O.^.. _�,.. _... _...
W® z 17 fndmemal Use ONLY
Client Name: . 922"-2572
P,V11 �� A� lm Projectl
Courier: Fed Ex ❑UPS ❑LISPS ❑Client 1111111111111111111111
❑ CommercLl Pace ❑Other:92292572
Custody Seal Present? Yes rr---�� ❑Yes ONO
❑ Lyr,lfJo Seals Intact? - )'
Packing Material: ❑Bubble WrapDate/Initials ➢erson@amining Conten 5Ip/
❑gobble gags None ❑Other:_
Thermometer: j61R SN: L22065387 ❑IR SN: 222055371 Type of ice: f1wet
Correction Factor. 0.0-C Cooler Temp Corrected (IC); �_3 Delve ❑None ❑Samples on ice, ccolind Process, has begun
Temp should be above fr ezing to 61C Biological Tissue Frozen? ❑yes ❑No ( -'J/A
USDA Regulated Soil ( LA water sample) T'
Did sampI"- originate In a quarantine zone within the United States: CA, NY, or SC (check maps)? Did s ❑Yes No
amples oPgina[e from a foreign source (internationally,
(�J
Includme Hawaii and Pvnnn➢i—i, r1— rA.,_
Correct Containers Used?
1.
LINO qN/A 1 R.
ONO Orr/A 9.
Sample Labels Match COC?
Dyes ONO ON/r, 12.
!,
-includes Date/rme/ID/Analysis Matrix
All containers needing acid/base preservation have been
-,,,......,,,rrr
checked?
tyl'es ONO ❑N(A 13.
Ail containers needing preservation are found to be In
compliance with EPA recommendation?
(HNOs, HnSOr, HO<2; NaOH>9 Sulfide, NaOH>12 Cyanide)
Yes ONO ON/A
Exceptions: VOA, Coliform, TOC, Oil and Grease,
LL%
Headspace In VOA Vials (>5-6mm)? byiis ON
Trip Plank Present? ❑Yes On.
Trip 9!ank Custody Seals Present? Oyes - ONO
Pace ?Lip Blank Lot 3 (ff purchased):
CLIENT NOTIFICATION/RESOLUTION
Perscn Contacted: '
Com. rents/Resciiution:
16.
Da; /TImJ.
Fleld Data Required? ❑Yes ❑No
Profit" Manager. SCURF Review: /: /
Project Manager SRF Review:
.. Note: ,y, n �/ _ _ Date:
wheneverthereisatllsaeoan, aHectIn• LarMhia compliance samples, a copy o:.:.,.
Out of hold, Incon.. preservable, out of temp. r-...:,led conlalr.ers) , ie `the North Carol is DEHHR Certification offee(i.e.
Page 9 of 10

��+�'c?PeAnal�flC�l
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CHAIN -OF -CUSTODY I Analytical Request Document
d TM Cnaln4-CuIIWy 2 a LEGAL DOCUMENT. AA rtlevanl fitlEr Musk be cmmplc¢0 xcu,ately.
'tc R x �
I
I REDULATORYj GENCY
,
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SkIme 10s MUST RE UNIQUE
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MODE R
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform,please visit: http�//portalncdenro-a/web/wq/ws/su/nodessw#tab-4
Permit No.: or Certificate of Coverage No.: N/C/G/_/_/_/_/_/_/
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: ARTe72
Date of Inspection:
Time of Inspection:
;4'SAn
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event' is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event' is a storm event that results in an actual discharge from the
j 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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
Page 1 of 2
SWU-242, Last moMied 10/25/2012

1. _- Outfall Description:—
Outfall No. 001 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North parking lot, roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L'1�6AX
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): 116wr
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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:
6) 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. Is there any foam in the stormwater discharge? Yes
S. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stonnwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
mayheindicativeo'fpollutantexposure. Theseconditionswarrantl'm-therinvestigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

�M
NC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling outthisform,please visit: htto�//12ortal.ncdenrora/web/wq/ws/su/node5sw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: _!yAluo i9i�c/Z
Date of Inspection:
Time of Inspection: /O:OrJ
Total Event Precipitation (inches): Q•] 7,0
Was this a'Representative Storm Event" or"Mensureable Storm Event" as defined by the permit?
(See information below.)
1� Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureablestorm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
j precipitation.
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
i interval is representative for local storm events during the sampling period, and the permittee
obtains anoroval from the local DWO Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: (?L6AR
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): /./Otitis
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: ^
9 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:
0 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. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
maybe indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

Ection A
Peru rep Ch,11 inlorma°on:
GU pity
Fehr Graham
°CeS 200 Prairie St
Section 3
Repulre0 PrcMcl Inhlrm?lion
5=359 9700 'giis 3 y-47op "`�"' rm(I R I
eruumd rare D.a,7AT: Standard Project Nrmte.
1 o
Section D Renmred Cnantlnlorrrulinn
nlaTeu cacti
SAMPLE ID
One Character per bo..
Sample IDa MUST RE UNIOUE
i=
Adaf timaal C aTments:
CHAIN -OF -CUSTODY / Analytical Request Document
The Chaln-of-Custody is a LEGAL DD�UMENT. All rale+ant fields must be :ompleted accurately.
Section C
hvpice H.1huli,"
uzzi
Mercer: Brian Pal-uzzi
Cpmpany Neme: Fehr Graham
/ddro:s'
200 Prairie St.,
St
.,are _op(s Reference:
�.c'eject M... ger Chris De roue n
Pace'mftle F:
,v
COLLECTED
_
W,
$
Wo
�,
4a
tj
t
<G
Etj
u
d
anATr-
11nrrr.
..._- _..�
•fL I(U(17
Marlo
X NPDES r GROUNDWATER DRINKING WaTER
=e 208 r UST I—RCRA OTHER
r GA 'L I IN MI X NO
• r' ON - Sc r 'A': OTHER_
Hit ererflYM) .11/AI
ter, Patch Rubber
SAMPLE CONDITIONS
z z z
r >
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2 Z
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0 Fll.:ALLCO20r.y.3.311.iar)5))22Ju12005

4 --
STORMWATER DISCHARGE OUTFALL (SDO
MONITORING REPORT
— Permit NumberNCS-000325? SAMPLES COLLECTUDttR1 Crblik DD EApji: 2016
(This monitoring report shall be received by the DivistJn no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PI]ONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
®Collected
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
110556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-1IEM), if
a 1.
Total
Suspended
Solids
p1I
New Motor
Oil Usage
mo/dd/ yr
MG
inches
m /1
m /l
unit
al/mo
Form SWU-247, last revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable— see permit)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of la ', that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure t at qualified personnel and
gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage c system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge d belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the possi4i ' y of fines and imprisonment for knowing violations."
(Signature yf Permittee)
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of March 2016. "No Flow"
Form SWU-247, lastrevised 21212012
Page 2 of 2

n
FEHRGFIMF�M
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7015 0640 0003 8993 0496
Return Receipt Requested
August 8, 2016
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
gUG 10 2016
CENTRAL FILES
DWR SECTION
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - July
Patch Rubber Company
1Ark PthRbb R d
a c u er oa
Weldon, INC 27890
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring
Report for st- rm�
water discharge from the above -referenced facility for July 2016.
Please note the following:
The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of July 2016.
The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
aqyl-d TAJrnu-�-)
Amy L. Trimble, CHMM
Environmental Scientist
ALT:m[L
Enclosures
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\16-105\Final\ALT 16-105 - Storrn Water SDO July 2016 Cover Letters.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL(SFo) ILECopyMONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Companv
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(Thu 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 Halifax
PHONE NO. 2( 52)536-2579
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activiry Monitoring Renuirement.
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GfrPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
moldd/vr
MG
inches
m
wo
unit
gafto
Form SWU-247, last revised 21217012
Page 1 of

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (Inches): N/A
Event Duration (hours): (only if applicable — see permit.).
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit)
Mall Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penaltylaw, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assosc that qualified personnel properly gather and evaluate the Information submitted. Based on my Inquiry of the person
or persons who mans - the system, or those persons directly responsible for gathering the Information, the Information submitted Is, to the
best of my knmvicti ' and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the posit Ilty of fines and imprisonment for knowing violations."
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of February 2016. "No Flow"
Form SW U-247, last revised 21212012
Page 2 of 2

E>,
FEHR QF1Afl4ff44,M
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7015 0640 0003 0331 4043
Return Receipt Requested
March 14, 2016
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVCOPY
MAR 17 .2016
CENTL FILES
DWR SECT ON
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - February 2016
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for February 2016.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of February 2016.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Amy L. Trimble, CHMM
Environmental Scientist
ALT: m l l
Enclosure
cc: Marto Carter, Patch Rubber Company
0APatch Rubber Company\16-105\Final\ALT 16-105 - Storm Water SDO February 2016 Cover Letter.docx
f
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I w'wwJehr-graham.com
Insight. Experience. Results.

FEHRGRAIll I&M
ENGINEERING & ENVIRONMENTAL
Certified Mail No. 7015 0640 0002 6881 3230
Return Receipt Requested
February 11, 2016 RECEIVED
Division of Water Quality FEB .25 2016
Attention: Central Files CENT
1617 Mail Service Center
Raleigh, North Carolina 27699-1617 SE OwR CTION
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - January 2016
Patch Rubber Company
100 Patch Rubber Road tC�
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:k6 to
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for January 2016.
UO
Please note the following: a<
The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of January 2016.
The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
� rn,,.4 -FA rfm �)
Amy L. Trimble, CHMM
Environmental Scientist
ALT:dId
Enclosure
cc: Marto Carter, Patch Rubber Company
Tim Donley, Patch Rubber Company
0:\Patch Rubber Company\76,105\Finat\ALT 16-105 -Storm Water SDO January 2016 Cover Letters. doc
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

FILECc)pt�v, STORA7WATER DISCHARGE OUTFACE (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitorine Requirements
Outfall
No.
Date 1
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-HEM), if
a I.
Total
Suspended
Solids
PH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m /1
m /I
unit
al/mo
Form SW U-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, tinder penalty o aw, that this document and all attachments were prepared tinder my direction or supervision in accordance with a
system designed to . r that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manag the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowlcdg and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the possib' ity of_Fnes and imprisonment for knowing violations.'
(Signature of Permittee)
212 711f
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of January 2016. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

7
Permit Number NCS 000325
STORMWATER DISCIIARGE OUTFALL (SDO)
MONITORING REPORT
FACILITY NAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(This monitoring report shall be received by the Division no later than 30 days from
the date'tlie facility receives the sampling results from the laboratory.)
<f
COUNTY Halifax
PIIONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorine Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-HEM), if
a pl.
Total
Suspended
Solids
pit
New Motor
Oil Usage
nio/dd/vr
MG
inches
m /I
In/1
unit
gallmo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation(inches): NSA
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
"I certify, under penalty of law,
system designed to assure that q
or persons who manage the syst
best of my knowledge and b (el
the possibility oflnes
(Signature of
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
tha,k1his document and all attachments were prepared under my direction or supervision in accordance with a
i ified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
im, or those persons directly responsible for gathering the information, the information submitted is, to the
true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
and imprisonment for knowing violations."
(Date)
The Facility was unable to collect the required samples from a 'Representative Storm Event'
for the month of July 2016. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

F E H R GFLAW-1 �M
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7015 0640 0002 6881 4701
Return Receipt Requested
December 15, 2015
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Storm-Water-Discharge-Outfall-(SDO)-Monitoring-Report --November 2015
Patch Rubber Company
100 Patch Rubber Road RECEIVED
Weldon, INC 27870
DEC 18 2015
NCS000325
CENTRAL FILES
Dear Sir/Madam: DWR SECTION
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for November 2015.
-Please note the following:
0
a
Storm water samples were collected during a representative storm event on
November 19, 2015.
`°
The results are below the facility's permit benchmark for each outfall.
If you have any questions regarding these documents, please do not hesitate to contact
this office. . .
Sincerely,
Amy L. Trimble, CHMM
Environmental Scientist
ALT: m 11
Enclosure
cc: Marto Carter, Patch Rubber Company
0APatch Rubber Company\15-105\FinaIWLT 15-105 - Storm Water SDO December 2015 Cover Letter.docc
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

(�52ceAnalyficale
www.p&Wabs.can
Amy Trimble
FEHR-GRAHAM &ASSOCIATES
200 Prairie Street, Suite 208
Rockford, IL 61107
Project: Patch Rubber Cc 105 11119
Pace Project No.: 92276963
Sample: OF 001 N
Laboratory Report
Lab ID: 92276963001
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)8344984
Page 1 of i
Report Date: 12/03/2015
Date Received: 11/19/2015
Collected: 11/19/15 08:00 Matrix: Water
Method
Parameters
Results
Units Report Limit
Analyzed Qualifiers
EPA 200.7
Zinc
342
ug/L .03r}arr,311, 10.0
12/01/1502:38
SM 5220D
Chemical Oxygen Demand
ND
mg/L 10.0
11/24/15 23:20
Sample: OF 002 S
Lab ID:
92276963002 Collected: 11/19/15 08:00 Matrix:
Water
Method
Parameters
Results
Units Report Limit
Analyzed"Qualifiers
EPA 200.7
Zinc
75.1
ug/L o.Ps7'MI1 JL 10.0
12/01/1502:41
SM 5220D
Chemical Oxygen Demand
ND
mg/L 10.0
11/24/15 23:20
Reviewed by: /'"_— -
Chris Derouen
[e-mail]
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NCO30
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
West Virginia Certification #: 356
VirginiaNELAP Certification #: 460222
Pagel of 3

��(�u.�aozawaa�Mag511zziwoo

�
Document Name: Sample Condition Upon
Document evised: May 15,201
-
/
Receipt SCUR
a e 1 of 2'
Document No.:
Iss Ing Authorities:
.PaCeAnalytical
! "' O« °°°•'^°•°°"
F-RAL-CS-001-rev.03
Pace R tel h Duali Office
'Page 2 clf 2 Is for Internal Use Only
Client Name: ,�alm
Courier (Circle): Fed Ex UPS USPS Client Commercial Pace Other
I
Custody Seal on CoolerlBox Present: C yes yf no Seals Intact: ;ell yes no
Packing Material: El Bubble Wrap 6 I Bags fY None ONer
Circle Thermometer Used: IR Gun :122065387T of Ice: Wet Slue None n Samples on foe, cooling process has begun
IR Gun Ba s771
Temp Correction Factor: Add / l btract
C
Date en Initials of pe eon IxaminIng
° a ! ry t
Corrected Cooler Temp.: C
Blolo Ical Tissue Is Frozen: Yes No /A
8
shoe:
Temp should be above freezing to 6'C
Comments:
Chain of Custody Present:
16Y. ONO
ON/A
1.
Chain of Custody Filled Out:
as ONO
OWA
2.
Chain of Custody Relinquished:
Ijys ON.
Offm
3.
Sampler Name S Signature on COC:
vas ONO
ON/A
4.
Samples Arrived within Hold Time:
VY6. ONO
OWA
S.
Short Hold Time Analysis c72hr :
OYea
ON/A
6.
Rush Turn Around Time Requested;
Oyes VNo
OwA
7.
Sufficient Volume:
OYes ONO
OWA
8.
Correct Containers Used:
Yes ONO
OWA
9.
-Pace Containers Used:
Ye. ONO
OWA
Containers Intact:
va ONO
OwA
10.
Filtered volume received for Dissolved tests
[)Yes ONO
QkA
11.
Sample Labels match COC:
tIYOA ONO
OWA
12.
-includes date/ tlme/ID/Anal sis Matrix:
I
AM wntaerere needing preservation have been checked.
lJYJJ
es ONO
❑N/A
13.
All containers needing preservation are found to be in
IYes ONO
ON/A
compliance Win EPA recommendation.
!!!
excepaau: VOA coliform. TOC, OaG. W WRO (water)
V os ONO
Samples checked for dechiodnatlon:
vas ONO
ONiA
14.
Heads ace In VOA Vials >Bmm :
OYes ONO
WIA
15.
Trip Blank Present:
OYee ONO
ANIA
16.
Trip Blank Custody Seals Present
Ores ONO
�N/A
Pace Trip Blank Lot f! II purchased):
Client Notification/ Resolution:
Person Contacted: Daterrime:
Comments/ Resolution:
SCURF /SRF / Date:
Review:: I S
Note: Whenever there Is a discrepancy affecting North Ca oilne compitance
samples, a copy of this forth will be sent to the North Caroline DEHNR
Certification Office I Le out of hold. incorrect presemthre. out of temp.
Incorrect containers) _
Field Data Required? Y / N
WO#:92276963
II011011IIIII III lip I II
92276963
'Page 3 of 3

CDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance onfilling out thisform, please visit. httr•//uortalncdenrm-g/web/wo/wslsu/imdessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: 4judl.o 1�7 eR
Date of inspection: 1I—/%—aOIS—
Time of Inspection: o.(/!J /Vm
`' r
Total Event Precipitation (inches): ©, `�
Was this a "Representative Storm Event" or "Measureable Storm Event' as defined by the permit?
(See information below.)
r ] Yes ❑ No
Please verify whether Qualitative Monitoring rnust be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storin 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 DWQ Regional Office.
By this signature,) certify that this report is accurate and complete to the best of my knowledge:
or Designee)
Pagel of 2
SWII-242, Lastmodified 10/25/2012

-1:--Outiall Description: — - -- --- - ----- - — — -- -
Outfall No. 001 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North parking lot, roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: WA «A
3. Odor: Describe any dis�tJinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): /VONLf
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
6) 2 3 4 5
S. 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 S
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. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes 6
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
maybe indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Lastmodified 10/25/2012

NC®ENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceair filling out thisform,please visit: htto•//nortal�, ncdenrorg/web/wo/ws1:iu/nndessw#tab-4
Permit No.: N/O/g/Q/Q/ 0/3 / 2 / 5/ or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: /%%Q/TLo (w4RTe"le
Date of Inspection: i /7- 'OWS,
Time of Inspection: 9"11PXM
Total Event Precipitation (inches):
Was this a 'Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
ail Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureablestorm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation. ..
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 annroval from the local DWO Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
or Designee)
Page 1 of 2
S WU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
Roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: �d C
3. Odor: Describe any distinct odors that the discharge may have (i.e, smells strongly of oil,
weak chlorine odor, etc.): /ltl ue
4. Clarity. Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
6) 2 3 4 5
S. 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:
'V 2 3 4 5
G. 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:
ail 2 3 4 5
7. Is there any foam in the
llst/toormwater discharge? Yes
8. Is there an oil sheen in the sto rmwaterdischarge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may he indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SW U-242, Last modined 10/25/2012

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
r
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
M" 9-0/' -
SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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 Halifax
PIiONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
I----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitorinz Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/f PH
(Method 1664
SGT-H EM), if
appl.
Total
Suspended
Solids
pit
New Motor
Oil Usage
mo/dd/yr
MG
inches
In /l
ru/I
unit
al/mo
I
Pone SWU-247. last revised 21212012
Page l of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, tinder 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 lines and imprisonment for knowing violations."
(Signature of Permittee)
6 —19 - 2p 1_S
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of May 2015. "No Flow"
Form SWU-247, lost revised 21212012
Page 2 of 2

?� STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(This monitoring report shall be received by the Division no later that 30 days frond
the date the facility receives the sampling results from the laboratory.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONENO. 2f 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
11
1
1
t '
Total
' .'
®
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity MonitorinL Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-HEM), if
a tl.
Total
Suspended
Solids
PH
New Motor
Oil Usage
mo/dd/ r
MG
inches
to /I
m g/1
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2
K.I

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — sec 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
"1 certify, under pen5iff of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to #ore that qualified personnel properly gather and evaluate the information submitted. Rased on my inquiry of the person
or persons who m age the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my now ge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the sibility of fines and imprisonment for knowing violations."
(Signatuyt of
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of December 2015. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

1
F E H R GR�'.NA
ENGINEERING & ENVIRONMENTAL
Certified Mal Number: 7015 0640 0002 6881 3087
Return Receipt Requested
January 6, 2016
North Carolina Department of Environment
and Natural Resources
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report
December 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find two (2) copies of the Storm Water Discharge Outfall (SDO) Monitoring
Report for storm water discharge from the above -referenced facility for December 2015.
Please note the following:
The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of December 2015.
The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
" -TA�r >-1u-�-)
Amy L. Trimble, CHMM
Environmental Scientist
n
ALT:dId
�z
n
M
CD
Cf)
cmi r-
�-
W�
M.Enclosures
cc: Mr. Marto Carter, Patch Rubber Company
T
Oi
z MA
N
O
0:\Patch Rubber Company\15-105\Finat\ALT 15-105 Storm Water SDO December 2015 Cover Letters.doc
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.2353643 I f:815.235.4632 I www,fehr-graham.com
Insight. Experience. Results.

f+ �
Permit Number NCS 000325
FACILITYNAMF. Patch Rubber ComDan
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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.)
PERSON COLLECTINGSAMPLE(S) Not applicable ��^
CERTIFIED LABORATORY(S) Lab # E
Lab #
JAN 2
Part A: Specific Monitoring Requirements - CEWFi Rq�SEr
COUNTY Halifax
PIIONENO. 2( 52)536-2574
"CURE OF PERMTTTEE OR DESIGNEE
IRED ON PAGE 2.
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part R- Vehicle Maintenance Activitv Monitorine Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-HEM), if
a 1.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches -
m /l
m I
unit
gaumo
Form SW U-247, last revised 21212012
Page I of 2

t�-
STORM EVENT CHARACTERISTICS:
Date
'Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of la that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure t qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the stem, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge avid elief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibiliEy fines and imprisonment for knowing violations."
(Signature of
/a /'1 /T
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of September 2015. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

A
FEHRGR�'.n,'�M
ENGINEERING & ENVIRONMENTAL
Certified Mail No. 7015 0640 0002 6881 2820
Return Receipt Requested
October 2, 2015
North Carolina Department of Environment
and Natural Resources
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
OU 2 3 Z015
CENTRAL FILES
DWR SECTION
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - September 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find two (2) copies of the Storm Water Discharge Outfall (SDO) Monitoring
Report for storm water discharge from the above -referenced facility for September 2015.
Please note the following:
The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of September 2015.
The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
aq-r d —FA nfmu-L)
Amy L. Trimble, CHMM
Environmental Scientist
ALT:dId
Enclosures
cc: Mr. Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\15-105\Final\ALT 15-105 - Storm Water SDO September 2015 Cover Letters.doc
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

s
_y
�
r
r:
Permit NumberNCS 000325
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING. REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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.)
FACILITYNAME Patch Rubber Company RECEIVED COUNTY Halifax
PERSON COLLECTING SAMPLE(S) Not applicable PHONE NO. 2( 52)536-2574
CERTIFIED LABORATORY(S) Lab # JAN 2 0 Z016
Lab # --CENTRAL ENTRAL FILES SIGNATURE OF PERMITTEE OR DESIGNEE C_U9
DWR SECTION REQUIRED ON PAGE 2. o
Part A: Specific Monitoring Requirements
r�
Outfall
No.
Date
Sample
Collected
50050
Total
Flow ifa
Total
Rainfall
pH
COD
Zinc
_
mo/dd/vr
MG
inches
uni ts
mg 7 L
mg TL
001
N/A
002
N/A
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes X no
(if yes, complete Part B).
Part R- Vehicle Maintenance Activitv Monitoring Requirements
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/vr
MG
inches
m /l
'm 1
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of 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 pers s directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, [rue, accura[ ,and complete. I am aware that there are significant penalties for submitting false information,
includingll possib' ,y,of fines prid impriso tt ent for knowing violations." ,
/3 7-oiS
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of March 2015. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

0
a
m
FEHRGRL'k" .1m
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 2120 0004 3138 8288
RETURN RECEIPT REQUESTED RECEIVED
APR 2 0 2015
April 3, 2015 CENTRAL FILES
DVUR SECTION
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - March 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for March 2015.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of March 2015.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:cId
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\15-105\Final\BJP 15-105 -Storm Water SDO March 2015 Cover Letter.doc
200 Prairie Street I Suite 208 1 Rockford, It 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight Experience. Results.

Permit NumberNCS 000325
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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.)
FACILTTYNAME Patch Rubber Company o�rEIVED
PERSON COLLECTINGSAMPLE(S) Ma to ar
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40 , 2 p 2016
Lab # jr,
Part A: Specific Monitoring Requirements
CENTRAL FILES
pWR SECTION
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
MOMS
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
D.. � D. llnl.:nln TRn n Arf:.ri„r arrnnifn rt t}P •PMP,1fC
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
2ppl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/
MG
inches
m
M%A
unit
gallmo
Form SWU-247, last miscd 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 08/31/15
Total Event Precipitation (inches): 0.22
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under natty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designe o assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons w manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my wledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including possibility of fines and imprisonment for ]mowing violations."
q �r�if
(Siena Perini (Date)
Form SWU-247, last rm ised 212/2012
Page 2 of 2

FEHRGR UIIIIIIIIIAM
111
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7015 0640 0002 6881 3599
Return Receipt Requested
September 15, 2015
N.C. Department of Environment
and Natural Resources
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, NC 27699.1617
RECEIVE®
St" 2 2 2015
CENTRAL FILES
�;IVR SECTION
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - August 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for August 2015.
Please note the following:
• Storm water samples were collected during a representative storm event on
August 31, 2015.
• The results for Zinc and pH are above the facility's permit benchmark for both
outfalls.
The facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
T./WY11�
Amy L. Trimble, CHMM
Environmental Specialist
ALT: mll
Enclosures
cc: Marto Carter, Patch Rubber Company
0APatch Rubber Company\15-105\FinaV\ALT 15-105 -Storm Water SDO August 2105 Cover Letter.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.1643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out thisform, please visit.- http://portaLncdem-.ora/ive /w /ws/su/nodessw#tab-4
Permit No.: or Certificate of Coverage No.: N/C/G/_/_/_/_/_/_/
Facility Name: Patch Rubber Company
County: —
Inspector:
alifax Phone No. 252-536-2574
Date of Inspection:
Time of Inspection:
's.a fiM
Total Event Precipitation (inches): ©- -2 Z ?W . S, 61Z
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
rj Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DW(
Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
A
or Designee)
Page 1 of 2
SWU-242, Lastmodified 10/25/2012

-.-- . —4---- - Outfall Description: ---- - ---
outfall No. 001 Structure. (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North jDarkinq lot roof drains
2. Color: Describe the color of the �l� harge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: /VdNa
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): Ndlv&,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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:
D2 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:
9 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes V�
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes 'o
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 10/25/2012

MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform,please visit.- htt�//nortalncdenr.ora/web/wo/ws/su/npdessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
InspectorAwl-C) GARTc/C
Date of Inspection: 8- 3 /- 07dLs-
TimeofInspection: 9;301tyw
Total Event Precipitation (inches): e Z Z
?0' !"32,
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
X Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
By this signature I certify that this report is accurate and complete to the best of my knowledge:
e- 3/-aolY
Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

---- --I.---- --Outfall Description:-- - - -- - -- - - -
Outfall No. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the dif charge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: oNir
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): NaAjz
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes 00
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

Section A
Repaired CO¢OI IOlOrmalb0:SectionG
Section B '
Company. Fehr Graham
Required Praia, Information:
rmallon:
ReporlT '
]
invoice Info
Adore:':
$rian PaluzziAttention]
200 Prailrie
St
capr rg:
cnmpanrN
Rockford IL
61107
ACdans:
E nal Te:
DD aluzzi@fehr-
raham
Proase Oder No.:
com
Pacn Ouole
P d1E
8 s-35y-97OD
Fy:
-3 y• q 7Da
Pro'eq amp:
Pacn Pmler
Requested Due DaIdTAT:
Standard
R b
ProIecl Number.
105
Pane PrerlF
Section Regilretl
Cllenl information
vutuAT"mm`ue..
SAMPLE
ID
wo
One Choral
ter pa a. bo
$
tt
E
(A.Z.
Sample Joe MUST
�b-91:)
BE UNIQUE
a�
awwanear
Additional comments:
CHAIN -OF -CUSTODY / Analytical Request Document
The Chainrof-Custody Is a LEGAL 000UMENT. All relevant rields must be completed accurately.
rian Paluzzi
-Fehr Graham
30 Prairie
St., Sl
Yelerence:
Manage: Chris
Derouen
I:
COLLECTED
<
¢
IF
T 1111E
[o RF11wu
I I�...�
w�
� V
o
V
a
Marlo
1x NPOES r GROUND WATER r DRINKING WATER
I
208 LI` UST Y RCRA F OTHERJ_
F GA 1r IL r IN r MI NC
• • r OH I- SCr WI r OTHER
I -
SAMPLE
s z
T j-
U _
r, Patch Rubber Co. a
Dote sgg�� [ytm Rubber
r S— A N
131— 3 - /� rc u n
I.
e-File(ALL0020rov,3,31 Ma105))22Jun2005

aceAnalytical
aw+ ParelabLoaa,
Laboratory Report
Amy Trimble
FEHR-GRAHAM & ASSOCIATES
200 Prairie Street, Suite 208
Rockford, IL 61107
Project: Patch Rubber Co 105 8/31
Pace Project No.: 92265894
Pace Analytical services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Page 1 of 1
Report Date: 09/14/2015
Date Received: 09/01/2015
Sample: OF 001 N
Lab ID:
92265894001 Collected:
08/31/15 09:21
Matrix: Water
Parameters
Results
Units Report Limit
Analyzed
Qualifiers
Zinc
855
ug/L 10.0
09/08/1512:32
Chemical Oxygen Demand
21.0
mg/L 10.0
09/14/15 14:10
M1
Sample: OF 001S
Lab ID:
92265894002 Collected:
08/31/1509:32
Matrix: Water
Parameters
Results
Units Report Limit
Analyzed
Qualifiers
Zinc
280
ug/L 10.0
0910811512:35
Chemical Oxygen Demand
19.0
mg/L 10.0
09/14/15 1410
ANALYTE QUALIFIERS
Ml Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
Reviewed by:
Gl�
Chris Derouen -
[e-mail]
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NCO30
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
West Virginia Certification #: 356
VirginiaNELAP Certification #: 460222
Page i of 3

5,
CHAIN -OF -CUSTODY 1 Analytical Request Document
TM CIubFWCu Wy is a LEGAL DOCUMENT. M laj• kR e E W.04 •r dy.
- REGt�Il.ATORY�ENCY�'t.
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BcB
Document Name: Sample Condition Upon
Racal t SCUR
Document Revised: May 15, 2015
Page 1 of 2'
Document No.:
F-RAL-CS-001-rev.03
Issuing Authorities:
Pece Relei h Qualit Office
Client Name: Eezv\,V G-lIr Q ,' 'Page 2 of 2 is for Internal Use Only
Courier (Circle): Fed Ex - UPS USPS Client Commercial Pace Other
Custody Seal on CoolarlBox Present: O yes V no Seals Intact: yes ❑ no
Packing Material: Q Bubble WrKN.12206_538
Bags (�' None Other
Circle Thermometer Used: IR Gu7T ofIce: Wet Blue None Samples on Ice, cooling process has begun
IR Dun B5371
Temp Correction Factor, Add ublract C
Corrected Cooler 7emp.:r Blologlcal
Date and Initials of per on
co o I r
xamining
on�
_ C
Tlsaue Is Frozen; Yee No WA
`1
thoek:�
Temp should be above freezing to 5'C
Comments:
Chain of Custody Present:
Yee ONO
ONIA
1.
_
Chain of Custody Filled Out:
Yee ONO
ON/A
2.
Chain of Custody Relinquished:
Yes ONO
ON/A
3.
Sampler Name d Signature on CDC;
Yes ONO
ONIA
4.
Samples Arrived within Hold Time:
Yes ONO
OWA
5.
Short Hold Time Analysis (<72hr :
OYes EAO
ON/A
6.
Rush Turn Around Time Requested:
OYea VN,
ON/a
7.
Sufficient Volume:
6Y.. ON.
OWA
8.
Correct Containers Used:
vas ONO
OWA
0.
-Pace Containers Used:
dy,, ONO
OwA
Containers Intact:
RfYos ONO
ONIA
10.
Filtered volume received for Dissolved tests
OYas ONO
C46
11,
Sample Labels match CDC:
AAh
Yea Ohm
ONIA
12.
-Includes date/dme/ID/Anal sis Matrix:
As containers needing preservatlon have been chocked.
Yea ONO
V
OWA
13.
All containers needing preservation ere found to be In
compliance with EPA reoommende6on.
(As LING
/T1
ONIA
exceptions: VOA MONO% TOC, 090, WbDRO(watee
lJYea ONO
Samples chocked for dechlorination:
Yas ONO
ONIA
14.
Headspace in VOA Vials >6mm '
OYee ONO
JO N/A
16.
Trip Blank Present:
Oyes ONO
N/A
16.
Trip Blank Custody Seals Present
Elves ONO
;6N/A
Pace Trip Blank Lot q If urchosedt:
Client Notification/ Resolution: Field Data Required? Y / N
Person Contacted: Daterfime:
Comments/ Resolution:
SCURFISRF
Review::
Date:
WO#:92265694
Note: Whenever mere Is a discrepancy affecting North Carolina compliance II II� I I�I II I�I II I �II
samples, a oopy of INS form Wit be sent to the Norm Carolina DEHNR
Certification Office (I.e out of hold, Incorrect pfoservalNe, cut of letup, 92265894
Incorrect containers)

Penn it Number NCS 000325
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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.)
FACILITYNAME Patch Rubber Company RECEIVED
PERSON COLLECTING SAMPLE(S) Marjo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40 JAN 2 0 2016
Lab #
CENTRAL FILES
DWR SECTION
Part A: Specific Monitoring Requirements
COUNTY Halifax
PIIONENO. 2( 52)536-2574
ISIGNATURE OF PERMITTEE OR DESIGNEE I
REQUIRED ON PAGE 2.
/ ®
1------ Collected
,®�
'f-J
---
1
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month'?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TP1I
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pit
New Motor
Oil Usage
mo/dd/yr
MG
inches
m /I
m /I
unit
al/nto
Form S WU-247. last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 04/30/15
Total Event Precipitation (inches): 0 . 5
Event Duration (hours): (only if applicable— see permit.)
(if more than one storm event was sampled)
Dale
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, trader 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. Rased 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. 1 am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
(Signature of Pennittee)
%-�-2OIS
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

M
FEHRGRAE-1 M
ENGINEERING & ENVIRONMENTAL
Certified Mail No. 7013 2630 0000 8070 4760
Return Receipt Requested RECEIVED
June 8, 2015 JUN 16 2015
Division of Water Quality CENTRAL FILES
Attention: Central Files DWR SECTION
1617 Mail Service Center
Raleigh, INC 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - April 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for April 2015.
Please note the following:
Storm water samples were collected during a representative storm event on
April 30, 2015.
The lab was unable to sample for COD. The sample containers were accidently
disposed of before the lab had a chance to analyze the sample. They were able to
analyze the sample for zinc. Please see enclosed letter from Pace Analytical.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Amy L. Trimble
Environmental Specialist
ALT: mll
Enclosure
cc: Marto Carter, Patch Rubber Company
0APatch Rubber CompanyA15-105\Final\ALT 15-105 - Storm Water SDO April 2015 Cover Letter.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 1 f:815.235.4632 1 www,fehr-graham.com
Insight. Experience. Results.

:.QaceAnaly?ical"
r
Pace Analytical Services, Inc.
2225 Riverside Drive
Asheville, NC 28804
Phone:[phone]
Fax:[phone]
May 20, 2015
Mr. Brian Paluzzi
Fehr Graham
200 Prairie Street
Rockford, IL 61107
Re: Client ID: Patch Rubber Co. 105 4/30/15
Pace Project ID: 92247954
Dear Mr. Paluzzi,
This letter is in regards to your outfall samples for your Patch Rubber Co. project from 4/30/15
(Pace project 92247954). The COD containers were accidently disposed of before the lab had a chance
to analyze the sample. We were able to analyze and report the metals portion of this project.
As a result of this error, we are in the process of seeking better ways to improve our operating
procedures to prevent any further occurrences of this type.
We apologize for any inconveniences this may have caused. If you have any further questions, please
feel free to contact me at [phone] or you can email me at [e-mail].
Sincerely
Chris Derouen

,�ace Analytical
M .pace/ab&=
Laboratory Report
BRIAN PALUZZI
FEHR-GRAHAM &ASSOCIATES
200 Prairie Street, Suite 208
Rockford. IL 61107
Project: Patch Rubber Co 105 4/30
Pace Project No.: 92247954
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
[phone]
Page 1 of 1
Report Date: 05/27/2015
Date Received: 05/01/2015
Sample:
OF 001 N
Lab ID: 92247954001 Collected:
05/01/15 11:18
Matrix: Water
Parameters
Results Units Report Limit
Analyzed
Qualifiers
Zinc
534 ug/L 10.0
05/06/15 16:38
Sample:
OF 002 S
Lab ID: 92247954002 Collected:
05/01/15 11:30
Matrix: Water
Parameters
Results Units Report Limit
Analyzed
Qualifiers
Zinc
107 ug/L 10.0
05/0611516:41
//
-
Reviewed by: G
Chris Derouen
[e-mail]
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
West Virginia Certification #: 356
Virginia/VELAP Certification #: 460222
Page 1 of 3

/ 6vl�•
o7,.P a
CHAIN-OF-CUSTODY.1 Analytical Request Document
^` / ^ TM W"d Cw Nh a LEGNG CUdENT. Mr an Aalft muU 0•Com0bN4 acaJtatey.
r,cw��"M=M
RECUL!I.TORKAG-- CY :
1•
C�K^J���',NC"
$ITc�■'
?s 7:R17T�'iK•71
1 •
CAON
• •
1��,,,,,,'_
SAMPLE ID
©■
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MINE
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INNER..
>-4•••■••••••••••........mmmmmM■■■■■■■■■■■■■■■■■■SIMMONS
■■■■■■■■■■■■■■■■e■■■mom
mmmMIM■■■■■■■■■■■■■■■■■■
ENEMIES '
RFUNv^UISHEDBY%AFFILIATDN
I:AD'AM � I,tE.
�..:CEPTED
BY AFiFI1:lATtpN��
DA
Icy atE
.
GN. TUR��L�7..1',i�
SN.iG, lER wV'E N1. o.51MOM-
'/ILA®®�®
/
0 FWLLGO20ew.J.J11du05))22J•,005
m
m
a

: April 04,
of 2
sae
Issuing
Pace Ashed
Client Name: tPV\x CCz.��L1�o
Where Received: Huntersville D Asheville (J Eden Ralelgh
Courier (Circle): - Fed Ex UPS USPS Client Commercial Pace . [her
Custody Seal on Cooler/Box Present: ❑ yes 0 no seals intact: yos [] no
Packing Material: Bubble Wrap Bu gs Non© Other '
Circle Themlomelor Used: IR Gun sj�i_22065380 of IcO: Weta Blue None Samples on Ice, cwling process has begun
IR-Gun Ba ... .. .... ........ ............._ . _..._
Temp Correction Factor: Add/ kuh act2
Corrected Cooler Temp.: C
C
Biological Tissue Is Frozen: Yes Ito q
Dateand Initials of porsone amining
co e t /Pr atl
check i
Temp. should be above freezing (a 6 0
Comments:
Chain of Custody . Present:
Zyw ONO
-DIVA
T.
Chain of Custody Filled Out:
Yes ONO
OwA
2.
Chain of Custody Relinquished:
6yw.ON.
OwA
3.
Sampler Name & Signature on COC:
yea ON.
OwA
4.
Samples Arrived within Hold Time:
J
P(Yos ONO
ON/A
5..
Short Hold Time Anal Is' <72hr :
Oyes 4N.
ONIA
6.
,
Rush Turn Around Time, Requested:
[)yes rso'
OWA
7.
Sufficient Volume:
Yes ONO
ONIA
8.
Correct Containers Used:
-Pace Containers Used:
�Yas ONO
pY ONo,
❑wA
OwA
9.
'
Containers Intact:
yes ONo
NIA
10.
'
Filtered volume received for Dissolved tests
Oyes ONO
ow
11.
Sample Labels matchCOC:
- sd'Yes ONO
OwA
12.
,
-Includes date/6me/lD/M61 sis Matrix
All containers needing preservationnave been checked.
dyes ONO
/fi(Yes
ONIA
13.
All containers needing preservation are found to be in
[IN.
OWA
compliance with EPA recommendation
r
exwptlonr. VOA coll(mm,TOC,O&G,WFDRO(water)
Yes ONO
Samples checked.for dechlorination:
dyes ON.
OwA.14.
Headspace in VOA Vials( >6mm):
Trip Blank Present:
Oyes ONO
[)Yes ONO
JNIA
(ONiA
15.
16.
Trip Blank Custody Seals Present
Oyes ONO
f IVA
Pace Trip Blank Lot 0 (if purchased). --
Client Notification! Resolution:
Person Contacted: Datefrime:
Comments/ Resolution:
SCURFlSRF Dale:
Review:: / S
Note: Whenever there is a discrepancy affecting North aroma ina compliance
samples, a copy of this form will be sent to die North Carolina DEHNR
rergficetiond.?ffice ( I.a out of hold, in
preservative, out of temp, .
incorrect containers)
Field Data Required? y I N
WO#:92247954
11111111111 �19111101611
92247854
Page 3 of 3

AnalyticalTM
)acelabs.com
me Form
Amy Trimble
FEHR-GRAHAM &ASSOCIATES
200 Prairie Street, Suite 208
Rockford, IL 61107
[phone]
' N\ VOICE
C Pace Analytical Services, Inc.
V G 6701 Conference Drive
Raleigh, NC 27607
Phone:[phone]
InNumber: 1592027663
Date: 05/29/2015
Total Amount Due: $34.00
Please Remit To:
Pace Analytical Services, Inc.
P.O. Box 684056
Chicago, IL 60695-4056
Client Numbei/Client ID -
Purcha'se Order Nd
' -Pace Project Mgr
.Teims
Page
91-100801 / 91-FEHR
Chris Derouen
Net 30 Days*
1
Client Project., Patch Rubber Cc 105 4130 Client Name: FEHR-GRAHAM & ASSOCIATES
Pace Project No: 92247954 Sample Received: 5/1/2015
Report Sent To: Amy Trimble, FEHR-GRAHAM & ASSOCIATES
Comments:
ANALYTICAL CHARGES
Quantity Unit
Description
Method
Matrix
Price
Total
2 Ea
1 Ea
200.71CP Metals
Shipping/Courier Charges
EPA 200.7
Miscellaneous Charges
Water
Water
$17.00
$0.00
$34.00
$0.00
Analytical Subtotal $34.00
Total Number of Charges 3 Total Invoice Amount $34.00
Samples Received for analysis:
Lab ID Client Sample ID Received
92247954001 OF 001 N 5/1/2015 2:40:00
92247954002 OF 002 S 5/l/2015 2:40:00
If you have any questions or to pay by credit card, please contact Chris Derouen at Pace.
Phone: [phone] Email: [e-mail]
Page 1 of 1
**1.5% MONTHLY FINANCE CHARGE ASSESSED AFTER 30 DAYS OR TERMS OF CONTRACT.
PLEASE REFERENCE THE INVOICE NUMBER ON ALL REMITTANCE ADVICE.
AN EQUAL OPPORTUNITY EMPLOYER
Please complete and return copy of invoice with your payment.
INVOICE TOTAL $34.00
Amount Paid: $
Check No:
Customer No: 91-100801 Invoice No: 1592027663

l
CDE R
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfillingoutthisform,pleasevisit.-'Iittp_//pot,tal.ncdeiir.org/web/wq/wslsu/iipdessw#tab-4
Permit No.: N/0// Q/Q/ 0// 2 / 5/ or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax ' Phone No. 252-536-2574
Inspector: AR40 CAA -Mt
Time of Inspection:
Total Event Precipitation (inches): 92 0
Was this a "Representative Storm Event" or "Measureable Storm Event' as defined by the permit?
(See information below.)
NYes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
performed during a "representative storm event' or during a "measureable storm event" However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative. storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0,1. inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWO Recional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Si iature o�mittee or Designee)
_.. .. ... _ _.. - Page l.of2, _
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
North parking lot, roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: 7VDN 9-
3. Odor: Describe any
weak chlorine odor, etc.):
odors that the discharge may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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-his-no solids and-5-is-extremely-muddy;
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
B. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may he indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SW U-242, Last modified 10/25/2012

AMr
MCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit httu•%[pmtal ncdenr ora/web/wa/ws/su/npdessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: M,4440 CA&;T-R
Date of Inspection: �f-3o-ao/S
Timeoflnspection M--------_.
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
1.4 -
Please verify whether Qualitative Monitoring mustbe performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
.Qualitative monitoring -requirements var-y._Most.permits-require, qualitative -monitoring .to -be.---- -- -----.--_-----
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted 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 DWQ Regional Office.
Permittee or Designee)
Page 1 of 2
S W U-242, Last moditled 10/25/2012

1. Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream: Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
Roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _/i�oAt
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): JV 0Akf
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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:
JP 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 i.s._extremelymuddy;._
Q 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes (No J
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? 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
SW U-242, Last modified 10/25/2012

w
_ STORMWATER DISCHARGE OUTFALL (SDO)
Z^ MONITORING REPORT
Permit NumberNCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PFIONENO. 2( 52)536-2574
mil
ISIGNATURE OF PERMITTEE OR DESIGNEE I
F9
REQUIRED ON PAGE 2.
G'tt'
Outfall
No.
Date
Sample
Collected
50050
Total
Flow ifa
Total
Rainfall
pH
COD
Zinc
mo/dd/vr
MC
inches
units
mg L
mg L
001
N/A
002
N/A
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month'? _ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitorina Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GITPH
(Method 1664
SGT-HEM), if
a I.
Total
Suspended
Solids
pit
New Motor
Oil Usage
mo/dd/yr
MG
inches
m /I
mg/1
unit
gallino
Form SWU-247, last revised 21212012
Page 1 of 2

-M
STORM EVENT CI[ARACTERIS"TICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 certify, under penalty of law, that this document and all attachments were prepared tinder nay 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."
of Permittee)
-f-Ib-
(Date)
The Facility was unable to collect the required samples from a 'Representative Storm Event'
for the month of June 2015. "No Flow"
Form S W U-247, last revised 21212012
Page 2 of 2

Fj
FEHRGRAff-1 M
ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7015 0640 0004 6574 3231
Return Receipt Requested
July 14, 2015
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - June 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
RECEIVED
JUL 21 Z015
Dear Sir/Madam: CENTRAL FILES
DWR SECTION
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for June 2015.
Please note the following:
The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of June 2015.
The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Amy L. Trimble
Environmental Specialist
ALT: mll
Enclosure
cc: Marto Carter, Patch Rubber Company
0APatch Rubber Company\15-105\Finat\ALT 15-105 - Storm Water SDO June 2015 Cover Letters.doc
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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.)
FACILITYNAME Patch Rubber CompanV
PERSON COLLECTINGSAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Parr R: Vehicle Maintenance Activitv Monitorinp Requirements
Outfall
No.
Date -
Sample
Collected- '
50050
00556
00530
00400
Total Flow
(if applicable)
Total,
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GITPH
(Method 1664
SGT-HEM), if
a 1.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
In /I
m /I
unit
'al/mo
Form SWU-247, last revised 21212012
Page I of 2
I

\�
C
STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of 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."
I �-�, �% kl-e� $ - 14 - 15
(Signature of Permittee) (Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of July 2015. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

r,
FEHRGR�'.",'�M
ENGINEERING & ENVIRONMENTAL
Certified Mail No. 7015 0640 0004 6574 3194
Return Receipt Requested
August 10, 2015
North Carolina Department of Environment
and Natural Resources
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
13 19 2015
CENTRAL FILES
DWR SECTION
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - July 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find two (2) copies of the Storm Water Discharge Outfall (SDO) Monitoring
Report for storm water discharge from the above -referenced facility for July 2015.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of July 2015.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
" T✓�-UY>'lU-S—)
Amy L. Trimble, CHMM
Environmental Specialist
/_TWC1CJ
Enclosures
cc: Mr. Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\15-105\Final\ALT 15-105 - Storm Water SDO July 2015 Cover Letters.doc
y
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Marlo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PACE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes Xno
(if yes, complete Part B)
D....• a. V..6:..1.. M.. etoe o....o Anf;x4 .r A4nnitnrin0 Rnm•irnmrntc
Outfall
No.
Date
Sample
Collected
I
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 A
mg/1
unit
al/mo
Form SWU-247, last revised 21212012
Page I of 2

f
STORM EVEN'I'CIIARAC'1'EIZISTICS:
Date O1/12/15
Total Event Precipitation (inches): 0.. 5
Event Duration (hours): (only if applicable —see permit.)
(if more than one storm event was sampled)
Date
'rotal Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central piles
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 syst or those persons directly responsible for gathering the information, the information submitted is, to the
best of m ° knowledge and bel' , rue, accurate, and complete. I am aware that there are significant penalties for submitting false information,
in ing tl a possibility of f} a and imprisonment for knowing violations."
of
a a aois
(Date)
Form SWU-247, last revised 21212012
Page 2 of 2

rE
Aff-v M
FEHRGR
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 5457 6235
RETURN RECEIPT REQUESTED
January 26, 2015
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - January 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for December 2014.
Please note the following:
• Storm water samples were collected during a representative storm event on January
12, 2015.
• The result for Zinc is above the facility's permit benchmark for outfall 001 only.
The facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
6,U-%,- ) N'
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:ctd
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\15-105\Final\BJP 15-105 - Storm Water SDO January 2105 Cover Letter.docx
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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 Halifax
PHONE NO. 2( 52)536-2574
Cz
SIGNATURE OF PERMITTEE OR DESIGNEE
REOUIRED ON PAGE 2.
�
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Requirements
Outfall
No.
Date
.Sample
Collected
50050
00556
100530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil &•Grease
(if appl.)
Non -polar
O&GfTPII
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage '
mo/dd/ r
MG
inches
m /I
mg/1
unit
al/mo
Form SWU-247, fast revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under pe Ity of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to sure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons whoA nage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my kno dge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the sibility of tines and imprisonment for knowing violations."
of Permittee)
t? 10/Ir
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of October 2015. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

FEHR GR�:",'�M
ENGINEERING & ENVIRONMENTAL
.Certified Mal Number: 7015 0640 0002 6881 4428
Return Receipt Requested
November 6, 2015
North Carolina Department of Environment
and Natural Resources
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report
October 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
Dear Sir/Madam:
RECEIVE®
NOV 13 2015
CENTRAL FILES
DWR SECTION
Enclosed please find two (2) copies of the Storm Water Discharge Outfall (SDO) Monitoring
Report for storm water discharge from the above -referenced facility for October 2015.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of October 2015.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
aq-(\-d T-�UL-P-)
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosures
cc: Mr. Mario Carter, Patch Rubber Company
OAPatch Rubber Company\15-105\Finat\ALT 15-105 - Stonn Water SOO October 2015 Cover Letters.doc
221 E. Main Street I Suite 200 1 Freeport, It 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graharn.com
Insight. Experience. Results.

"Permit Number Number NCS 000325
STORMWATER DISCHARGE OUTFALL (SDO)
RECEIV ITORING REPORT
ll�.++ SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(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.)
MAR. 1 3 2015
CEMTRAL FILES
FACILITYNAME Patch Rubber CompanvDWRSECTION
PERSON COLLECTINGSAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONE NO. 2( 521536-2574 �e
Qa
SIGNATURE OF PERMITTEE OR DESIGNEE Qz
REOUIRED ON PAGE 2.
Outfall
No.
Date i - -
Sample
Collected
50050
Total
Flow ifa
Total
Rainfall
pH
COD
Zinc
mo/dd/ r
MG
incites
mg TL
mg L
001
N/A
002
N/A
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part It: Vehicle Maintenance Activitv Monitorine Requirements
Outfall
No.
Date ;
Sample _
Collected
50050 '
00556
00530
100400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/PPII
(Method 1664
SGT-IIEM),if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m /I
nt /1
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2

`STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable-- see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one cop), to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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 beli , true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
�d including,ttssibility of fi s and imprisonment for knowing violations."
3 1/ JAass'
(Da )
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of February 2015. "No Flow"
Form S W U-247, lost revised 21212012
Page 2 of 2

FEHRGR�`. IA 14
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 5457 5467
RETURN RECEIPT REQUESTED
March 4, 2015
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - February 2015
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
® Dear Sir/Madam:
M
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
awater discharge from the above -referenced facility for February 2015.
v
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of February 2015.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
/3A4.1-1 ) P
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:ctd
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\15-105\Final\BJP 15-105 -Storm Water SDO February 2015 Cover Letter.doc
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S)Marjo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(This monitoring report shall be received by the Division no later than 30 days ronr
the date the facility receives the sampling results from the laboratory.)
COUNTY Halifax
PHONENO. 2f 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REOUIRED ON PAGE 2.
MJ
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes X no
(if yes, complete Pan B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
.No.
Date
Sample'
Collected
'
j
50050
100556
0053
000400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GfrPII
(Method 1664
SGT-IIEM), if
a 1.
Total
Suspended
Solids '
PH
New Motor
Oil Usage
mo/dd/'r
MG
inches
m /I
m
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVIsN'I' CIIAizACTERIS'1'ICS:,
Date 12/16/14
'total Event Precipitation (inches): 0.3
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration(honrs): (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, tinder 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, ycurate, and complete.- I :mt aware that there are significant penalties for submitting false information,
includin;Ae r ibility of fines and i prisonment for knowing violations.'
/Az lya-5-
(Date7
Form S W U-247, last revised 21212012
Page 2 of 2

FEHRGRAI-IM
s�
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 6467 2910
RETURN RECEIPT REQUESTED
January 5, 2015
RECEIVED RECEIVED
Division of Water Quality JAN 4 2015 JAN 14 ?L;
Attention: Central Files CENTRAL FILES CENTRAL FILES
1617 Mail Service Center DV'/R SECTION DVIIR SECTIOI\I
Raleigh, NC 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - December 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, INC 27870
NCS000325
® Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
a water discharge from the above -referenced facility for December 2014.
Please note the following:
• Storm water samples were collected during a representative storm event on
December 16, 2014.
• The result for Zinc is above the facility's permit benchmark for each outfall.
The facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP/ja
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO December 2014 Cover Letter.docx
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394A700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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.)
FACILITY NAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
P11ONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B• Vehicle Maintenance Ac ivity Monitoring Requirements
Outfall
No. -
- - -
Date
Sample
Collected
-
-
50050
00556
,0053W _ i
WOW;-
TotalFlocv
(ifapplicable)
Totals
-Rainfall
-
Oil &-Grease
(ifappl.)
:Non -polar
A&G/rPH , -,
(Method 1664,
'�SGT-HEM); ifv
appl.
7 otalo ;
Suspended
Solid`s-
. ,
,..
ipHr
-
-
New Motor
Oil`Usage
-
'
mo/dd/ r
MG
inches
m I
-:
m .'unit
gaumo
Form S W U-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of 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 persa directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and 'efj true, accurate, d complete. I am aware that there are significant penalties for submitting false information,
including the possib' y of fines and imprison, nt for knowing violations."
(Signature of
a 3v ao!
(Date)
The Facility was unable to collect the required samples from a 'Representative Storm Event"
for the month of November 2014. "No Flow"
Form SWU-247, fast revised 21212012
Page 2 of 2

FEHR GRL:ri,'�N!
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 5457 5382
RETURN RECEIPT REQUESTED
December 16, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - November 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
X Dear Sir/Madam:
0
aEnclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for November 2014.
a
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of November 2014.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
6 P4. v
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP/cld
Enclosure
cc: Marto Carter, Patch Rubber Company
. 0:\Patch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO November 2014 Cover Letter.doc
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

Permit Number
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PIIONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
-------��Was#
ml-
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorine Requirements
Outfall
Date
50050 - -
-
00556
-:,,.
b0530,..,-, _ :.
00400
No.
Sample
Total Flow
Total--
Oil S Grease
N,on polar
Fotol :
pIF;
New Motor
Collected
(if applicable)
,RitioGilF
(if appl.)_
O&C/1'PHl ""
C3iispended
Oil Usage
"
"(Nlethod.l6(,4r�
;SGT IILNI) ifi
.
opp 1
mo/dd/vr
MG
inches
mg/1
,'
m I.
limit --
al/mo`-.`
Form SWU-247, last revised 21212012
Page 1 of 2

.r-
STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable— see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of 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 kn Jcdge and belief, ue, accurate, and complete. I am aware that there are significant penalties for submitting false information,
includes a possjWl4y of fines nd imprisonment foreknowing violations."
of
5 i s aoi
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of April 2014. "No Flow"
Form S WU-247, last revised 21212012
Page 2 of 2

FEHRGRAE-1 �M
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 5457 5177
RETURN RECEIPT REQUESTED
May 9, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - April 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
® Dear Sir/Madam
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for April 2014.
a
D Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of April 2014.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
13 n ) P -
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:ja
Enclosure
cc: Marto Carter, Patch Rubber Company
0APatch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO April 2014 Cover Letter.doc
200 Prairie Street I Suite 208 I Rockford, IL 61107 I p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Marjo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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 Halifax
PHONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEF, OR DESIGNEE.
REQUIRED ON PAGE 2. rr ^
GA\ IJr 1 A
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Ac ivity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m l
m l
unit
galtmo
Forst SWU-247, last revised 21212012
Page 1 of 2

SfO101 EVENTCHARACTERISTICS:
Date 07/09/14
Total Event Precipitation (inches): 0.16
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Dale
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 trader 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 any knowledge and b tef, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
ineludi po *ility of nes and imprisonment for knowing violations."
of
S-d0��
(Date)
Form S W U-247, last revised 21212012
Page 2 of 2

FIHRGR�'" lim
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 6467 2668
RETURN RECEIPT REQUESTED
July 29, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Storm Water Discharge Outfall
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
(SDO) Monitoring Report - July 2014
®
Dear Sir/Madam:
K
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
awater
discharge from the above -referenced facility for July 2014.
Please note the following:
• Storm water samples were collected during a representative storm event on July 9,
2014.
• The result for Zinc is above the facility's permit benchmark for outfall 001 only.
The facility has already implemented its Tier 2 response, and will continue monthly
r
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
/3.
Brian J. P luzzi, P.G.
Project Environmental Scientist
BJP:ja
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO July 2014 Cover Letter.do
200 Prairie Street 1 Suite 208 I Rockford, IL 61107 I p:815.394.4700 1 f:815.394.4702 1 www.fehr-graham.com
Insight. Experience. Results.

FEHR GR�:n,'�1�
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 6467 2965
RETURN RECEIPT REQUESTED
November 7, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
NOV 18 2014
CENTRAL FILES
DWR SECTION
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - October 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
ws
X1 Dear Sir/Madam:
m
Q Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for October 2014.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of October 2014.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP/ja
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO October 2014 Cover Letter.doc
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
('Phis 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 Halifax
PIIONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
1
Date
Sample
Collected
1 1
-------
I'otal
Flow (if app.)
Total
Rainfall
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
part B: Vnhirin Mnintrnn nrr Artivity Mnnitnrinu Remuiremenk
Outf:dl
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if nppl.)
Non -polar
O&GfrPli
(Method'1664
SGT-ITEM), if
appl.
Total
Suspended
Solids
PH
New Motor
Oil Usage
nm/dd/ r
MG
inches
mg/1
m
unit
gaurno
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable - see permit.)
Mail Original and one copy to:
Division of Water Quality .
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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 qua ' ted personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the syste , or those persons directly responsible for gathering the information, the information submitted is, to the
best of nowledge and belief true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
inctuding the possi ity of fip s and imprisonment for knowing violations."
of
1 b
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of October 2014. "No Flow"
Form SWU-247, lust revised 21212012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab 0
Lab q
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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 Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
----------
----------
----------
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part R- Vehicle Maintenaner Activity Monitorinp Reauirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
_
Oil & Grease
(if appl.)
Non -polar
O&Gfl'PII
(Method 1664
SGT-IIEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
.MG
inches
m I
In/I
unit
al/mo
Form S W U-247, last revised 21212012
Page I of 2

STORM EVENTCHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable - see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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, rue, accurate, and complete. I am aware that there are significant penalties for submitting false information,
includi the p ssi 'li[y of fin nd imprisonment for knowing violations."
(Si re of m' ee) (Date
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of October 2014. "No Flow"
Form SWU-247, lost revised 21212012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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.)
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY Halifax
PHONENO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity 'Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GrrPII
(Method 1664
SCT-ITEM), if
appl.
Total
Suspended
Solids
P11
New Motor
Oil Usage
i
mo/dd/yr
MG
inches
m /I
mg/1
unit
ntl/mo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CFIARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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 qualifie'0 personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons w age the system, those persons directly responsible for gathering the information, the information submitted is, to the
best of nowlqage and belief, tr e, accurate, and complete. I am aware that there are significant penalties for submitting false information,
inc ing the possib,pk of fines 9 d imprisonment for knowing violations."
9-a3-ao/j/
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of August 2014. "No Flow"
Form SWU-247, last revised 21212012
Page 2 of 2

F I H R GRt::-IffAk
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 6467 2705
RETURN RECEIPT REQUESTED
September 16, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - August 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, INC 27870
NCS000325
DD ® Dear Sir/Madam:
m
n
aEnclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for August 2014.
Please note the following:
The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of August 2014.
The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:ja
Enclosure
cc: Marto Carter, Patch Rubber Company
0APatch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO August 2014 Cover Letter.doc
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

STORM!NVATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) Marlo Carter
CERTIFIED LABORATORY(S) Pace Analytical Lab,# 40
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2 014
(]'his 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 Halifax
PHONE NO. 2f 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
_ REOUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
50050
'
Total
Flow ifa
Total
Rainfall
,pH
-
COD
Zinc
mo/dd/y r
MG
inches
units
mg L
mg L
001
09/24/14
0.25
5.73
29.0
0.656
002
09 24 14
0.25
5.69
27.0
0.177
T
'
L 014
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No..
Date
Sample
Collected
50050
-
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
-
i -
Non7polar
O&G/TPII -
(Method 1664
SGT-I-IEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
_
mo/dd/ r
MG
inches
m 4
mg/I
unit
gaumo -
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 09/24/14
Total Event Precipitation (inches): 0.25
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, tinder 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. [lased 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 thel
best of my knowledge a d belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
includme possibil' , of tines and imprisonment for knowing violations."
I
(Sign re o mittee) (Date
Form SWU-247, last revised 21212011
Page 2 of 2

FEHRGR� ff-1 li I
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 6467 2781
RETURN RECEIPT REQUESTED
October 9, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - September 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, INC 27870
NCS000325
® Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
6 water discharge from the above -referenced facility for September 2014.
a
v
Please note the following:
• Storm water samples were collected during a representative storm event on
September 24, 2014.
• The result for. Zinc is above the facility's permit benchmark for each outfall.
The facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Brian J. P luzzi, P.G.
Project Environmental Scientist
BJP/ja
Enclosure
cc: Marto Carter, Patch Rubber Company
t•
0:\Patch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO September 2014 Cover Letter.docx
200 Prairie Street I Suite208 1 Rockford, IL61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience: Results.

0
r
STORAIWATER DISCHARGE OUTF
rl
MONITORING REPORT
Permit Number NCS 000`2-35--
FACHATYNANIE
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAINIPLES
(This monit,
the (late the
11,1,(SI)O)
A?CTFD DURING CALENDAR YEAR: W�+
report shall be received by the Division no later than 30 days from
ty receives the sampling results from the laboratory.)
COUNTY
(Sl(;NATURE OF PERNHWEE OR DESIGNEE)
4�—Kls signature, 1 certiry that this report is accurate
complete to the best of my knowledge.
Outfali'llu"-v
i
nio/ddN-r,' %;AIQ
50050!*. nl',- T,
'.Ihiw:(1
hic ies j
d
'WX
K
NO
FZiR-V\C9,-kw0
MI,
1 9 9MA
Does this facility perform n) Vehicle Maintenance Activities using mote than 55 gal lone of new motor oil p imunth?—yes no
(it yes, complete Part 13)
Part It: Vehicle Maintenance Activitv Monilorins, Renniremmik
Outiall
50050
1.00556,,
1.
1
A530
00400 -,4f!: —
INII;
Totai,,P, m
Oil;& Grcase'�,':`
Noulpolai,, j
(wapplicable),'
K-111111all
(i1applI)
ON(WITIJ; -i
SUS'pen6d'i
..... .....
(,) 11, U sage;
iie
(Nief1k)(H664
4
Solids '
r�.qa
'P
SGT' 1EINI) 1
fl
NIG
ihiaii!s-
""I
4inici':
_U
Form SWU-247-0623 10
Page I of 2

STORM EVENT CHARACTERISTICS:
Dale
Total 1?rent Precipitation (inches):
Event Duration (hours): (only if applicable —see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Dtvation (hours): (only if applicahle — see permit.)
"I certify, tinder penally of law, that this document and all attachments were prepared
system designed to assure that qualified personnel properly gather and evaluate the in]
III persons who manage the system, or those persons directly responsible for gathering
of my knowledge and belief, true, accurate, and complete. I am aware that there are si
including the possibility of fines and imprisonment for knowing violations."
(Si nature it Pennillee)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
my direction or supervision in accordance with a
on submitted. Based on my inquiry of the person
mrmalion, the information submitted is, to the best
at penalties for submitting false information,
3I I 1
Form SWU-247-062310
Page 2 of 2
a

Phone [phone]
Fax [phone]
08/06/2014
Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC, 27699-1617
Subject:
-Tier Two Reporting for Formaldehyde. (Beginning date: 01/2014)
3440 Denton Road
Thomasville, N.C. 27360
-Tier Two Reporting for Nitrate + Nitrite, Nitrogen. (Beginning date: 03/2014)
Tier Two reporting requirement for Stormwater permit #NC000235
Attached is one original and one copy of the Storm Discharge Outfall (SDO)
Monitoring Report for the period of July 2014.
No sample was collected due to insufficient rainfall and no discharge from the
outfall during this period. The SDO monitoring report is filed to comply with
Tier Two requirements.
Please call 336-475-1348, or email: [e-mail], if you have
any questions or need additional information.
Sincerely,
John Myers "
Quality Man r
Attachments

Phone [phone]
Fax [phone]
04/16/2014
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC, 27699-1617
Subject:
3440 Denton Road
Thomasville, N.C. 27360
M
APR ) 3 2014
Annual reporting for Acute Toxicity testing for Stormwater permit #NC000235.
Attached is one copy of the Storm Discharge Outfall (SDO) Monitoring Report
for the period January thru June 2014.
Please call 336-475-1348, or email: [e-mail], if you have
any questions or need additional information.
Sincerely,
John Myers
Quality Manag r
JQ-f\A
Attachments

e
w

A
Permit Millibut NCS
I —
FA CAUTY NA M E
PFRSON (,'OLI,RCrIIING SAMPLR(S) 7
"I"" 1k: SPecillc N10"it(Wilig Requirements
Oilt1''11101'
STORNINVATER DISCII,I,RGIC OU,1,1��I'1' (SI)O)
MONITORING RIUIOR'I'l
SA N1 PLITS i
(This Illolli(i
file date the
Does this facilily pe.1folill V'j'j'j' Njojllten;mco Activities jjsjjj,, Ilmle than 55 pilons ot'new moor ()ij
(if yes, Complete I'mt 11)
";"I It: Vehicle MililltelelliceAc
,U,CTED DURING CALENDAR YIKAR:20i'j--
g report shall he received by (lie Division [m —later Ilum 30 days from
lity receives (Ile Sampling results from the laborallory.)
COUNTY moo, ?J
1'110y� NO. (-5'30
(SIGN IT RE OF IT R M ITTEE OR DES IGN E IT,)
I- C'
complete to, the hest of my kii(mviedge,
Y.
ry I-v
month? __ yes _�
Old-111
tM , ,
1,
00550;�.
� " , I,
11V ­ �IVI tL
;I IZ. iy�
, .
00530
-
...... ... .
No
to
N ul
*
.
00400
�
oe,­
j
fi
Kaill
e
0,
'-
(N Alod!,gig
uil3Usagc
MSc
I'
I'
rrrlb
6A I it 1._
11111 le
ij, 14
it &Lj'
g:1 11101
I'm III SNVIJ-247-0623 10
Page I A 2

�J
SI'URh9
Flail Origiu:d and one copy to;
I late Division of Water Quality
f [ A
Total Even(recipilalion (inches): lul: Central Piles
Event Duration (hours): (only if applicable— see pennit.) 1617 Mail Service Center
Raleigh, North Carolina 27699-1617
(if more than one stone even[ was sampled)
Date
Tidal Rveut Precipitation (inches):
Event Dul-atton (hours): __ (only if applicable — see permit.)
''I cc] dry, under lienalty or law, (hill this document and all attachments were prepared on lice lily direction or supervision in accordance with a
"V eur designed to assure Ihat qu:diHed personnel properly gadwr and.enduale the hilim a Hun submitted. Based on ary inquiry' or the peso❑
Inr pc trans who manage the sysleny or Ilmse persons directly responsible for Wnlhcring the iufornudiou, the information submitted is, to the hest
ul' my I:unwludge and belie[', True, accurate, and couplefe. I ant aware that there are signittc lit peuallies fur submilling Use information,
including the possibility or fines and imprisonmenl fur Knowing viulati my,'
(5(!I(ur � of Permiltee) I
� (I7al 1
Form SWU-2,17-062310
Page 2 of 2

STORMWATER DISCHARGE oUTr
MONITORING REPORT
Pennit Number NCS �_i1Q���J SAMPLES C
(This numitul
the dale the f
C _
FACILITYNAME, DCh11Tkk-t_,,0Ln1 12�ko � j
PERSON COLLECTING SAMPLE(S)
cn;R rrrn?u Lnlluun'rolls(s)g��,y��j�t�_Lah�_r��i„�t�
1.11)4
A: Specific Monitoring Requirements
i
1, (s)o)
ILLECI'ED DURING CALENDAR YEAR:2-01�—
ng repurl shall he received by the Division uo later than 30 days from
cility receives file sampling results from the lahorafury.)
COUNTY
(SIGN, 'rUitE 0E4IERMIT'I'EE OR DESIGNEE)
signature, 1 certify that this repurl is accur;de
amgdeic lu the hest of my knowledge.
}
Outt 111 , ,
}
cZl
D itc � S a I
S Illlpl 6 Z Y
(;Ill I1ltl(II5
- 1 },h
.'iwi/dd/1 r'�',;<-'w,<
i
Sllll�lllc l`r 31
lit
TI111 l fill)). 1.
pMCLJI .' �+!
., lu •n,u
tit n
« il. C`, k.�q .'
a 4l'jt; y;."
ilt lint ill r
',
utclYt s. u.r �r�fn
2-
I 'r
�— i
lO'k.�C.L'l Ya
L'fn
1 5
t. {c'
:.fl
r
i.��.
tazIt�
a ''�`Lt :xl.. I
�.tT.<,: I + s
, ,-
b 6 iC
,.J1i �) 1"',�-
t' t� JC
.f �l:. Zl�n ,$
4 YY' Y
vd, {, rn
...
R2g
r P
L t• �c
IB v
S W U-247-062310
Page I ol'2

STORM I?VENT CIIAItACh1�:ItIS'I'ICS:
)arc 3
T�J`I- I !
idal Event 'recipitation (inches): 0 ' ,
Evenl Duration (hours): (onl), if applicable — see permit.)
(if more than one storm CVCIIt Was sampled)
Da(e
"Total I?veut Preeipitalion (inches):
Event lluralinn(hours): (only it applicable — see permit.)
"I certify, under penalty of late, that this dncm"My and all atlachmenN were prepared unr
systunt designed to us.sure that gnulil'ied personnel properly gather and evaluate the "nm,
ur persons who manage the system, ur those persuns directly responsible fur gaM. wg the
of my lamwledge and belief, True, accm ate, :uul complete. I :un Invare that (here arc s1WW
including the possibility of fines and imprisounreut fur lumwing violations.•'
zf
1�
(R' = of I'enillnue) (Uah
Mail Original and one copy to:
Division of Water Qualily
Arm: Central Files
1617 Mail Service Center
Raleigh, North Carulina 27699-1617
er any direction or supervision in ncawdawe with :r
alien suhmitled. Based on my inquiry of the person
nfurmatiun, the information submitted is, to the best
cant penalties for submitting false information,
CLA(3 fpEsucrs Cec c Jed ckk)
Form SNVIJ-2117-062310
INge 2 of 2
A6

11
Phone [phone]
Fax [phone]
04/16/2014
Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC, 27699-1617
Subject:
3440 Denton Road
Thomasville, N.C. 27360
Annual reporting for Acute Toxicity testing for Stormwater permit #NC000235.
Attached is one copy of the Storm Discharge Outfall (SDO) Monitoring Report
for the period January thru June 2014.
Please call 336-475-1348, or email: [e-mail], if you have
any questions or need additional information.
Sincerely,
John Myers
Quality Manag
Attachments
11

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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 Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Ac ivity Monitoring Requirements
Outfall -
No. -
Date
Sample
Collected -
-500% -.
'00556. '.,00536i,
...
a00400
7otaUflo}v i
(If•applicable)
Toinh
-Rainfall,
Oil&cGrcasc '!Noii-polar
(tf apph:)
�ti(IVletho'
-.,
}O`6iGlI PH' °'
1664-°'Solids-
`.SGT IIEM);,if
Totalr`.'..- -,pI1'
Suspended'
New Motor
Oil Usage
.
nio/dd/ r•
bIG
inches
m 1'
m -
[unit
�al/mo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of 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 th se persons directly responsible for gathering the information, the information submitted is, to the
best of m ge and belief, true, curate, and complete. I am aware that there are significant penalties for submitting false information,
inc!Wlirrg the possi ili,%'of fines and prisonment for knowing violations."
!") t/
(Date
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of May 2014. "No Flow"
Form SWU-247, fast revised 21212012
Page 2 of 2

F I H R GRArkrvskHI
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7014 0150 0001 6467 3696
RETURN RECEIPT REQUESTED
June 3, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - May 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
ED Dear Sir/Madam
a _
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
a water discharge from the above -referenced facility for May 2014.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of May 2014.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
8A4--� Pam,
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:ja
Enclosure
cc: Marto Carter, Patch Rubber Company
O:\Patch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO May 2014 Cover Letter.doc
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

, _t
;_
Permit Number NCS 000325
RETWRING REPO CHARGE URT ALL (SUO)
JUL 0 8 Z014
CENTRAL FILES
DWOIBOG
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Marjo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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 Halifax
PHONE NO. 2f 52)536-2574
SIGNATURE OF PERM[n-rEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
Flow (if app.)
---
----------
----------
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitorinp Requirements
Outfall
No.
Date
Sample
Collected
50050
-
00556 _
_
00530 -
00400
'Total Flow
(if applicable) -
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&Grl'Pll
(Method 1664 .
SGT-I IEM),'if
appl.
" 'otal -
Suspended
Solids
-plI
,Ncw Motor
Oil Usage
nm/dd/Vr
MG
inches
In /I
mg/1
unit
gaunto
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date06/12/14
Total Event Precipitation (inches): 0.2
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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 in and belief, true, a urate, and complete. I not aware that there are significant penalties for submitting false information,
inclu g the-pbility of fines and iyfirisonnient for knowing violations."
Permittee)
(Date)
Form SWU-247,.last revised 21212012
Page 2 of 2

FEHR GRAkon ros,',Ilvl
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7013 0600 0001 5291 0995
RETURN RECEIPT REQUESTED
June 27, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - June 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
NCS000325
® Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
awater discharge from the above -referenced facility for June 2014.
v
Please note the following:
• Storm water samples were collected during a representative storm event on June
12, 2014.
• The result for Zinc is above the facility's permit benchmark for outfall 001 only. The
facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
B- d P
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:cId
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO June 2014 Cover Letter.doc
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

e
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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 Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE I
REQUIRED ON PAGE 2. I
Outfall
No.
Date
Sample
Collected
50050
Total
Flow(if a p.
Total -
Rainfall
pH
COD
Zinc
mo/dd/vr
MG
inches
mg 7 L
mg L
001
N/A
002
N/A
•`+V IV
`L-/
n
t^.1=NT0A I c❑
—n
t-
tN I KHL rlLt:
i
'
f11A1/11R(lc
v
UVvutbu(.i
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/1'PH
(Method 1664
SGT-ITEM), if
appi.
Total
Suspended
Solids
fill
New Motor
Oil Usage
nto/dd/vr
MG
inches
In 1
m /I
unit
aUmo
Form S WU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): - (only if applicable— see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of 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 ystem, or those persons directly responsible for gathering the information, the information submitted is, to the
best of owledge and _Ii f, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
inc 'n the Ability fines and imprisonment for knowing violations." -
of
W-a8-aaL
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event'
for the month of March 2014. "No Flow"
Form S WU-247, last revised 21212012
Page 2 of 2

FEHR GRAJ-1 �M
ENGINEERING & ENVIRONMENTAL
V
CERTIFIED MAIL NO. 7013 0600 0001 5291 1299
RETURN RECEIPT REQUESTED
April 14, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - March 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, INC 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for March 2014.
Cl
CL
cD
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of March 2014.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:ja
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO March 2014 Cover Letter.doc
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT .
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Marjo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab It
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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 Halifax
PHONE NO. 2( 52)536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REOUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
50050
-
-
Total
Flow if a
Total
Rainfall
pH
COD
Zinc
mo/dd/ r
MG
inches
units
mg L
mg L
001
02/18/14
0.2
6.37
<
0.466
002
02 18 14
7.1S
<10
0.067
01
1 v o_v
Ann
19Rt1
rvn
aw
(' NTIJ
�I GII c_c
Illl(I
Q0r%
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Reouirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
-O&G/TP11
(Method 1664
SGT-HEM), if
a '1
Total
Suspended
Solids
pH
-
'
.
New Motor
Oil Usage
mo/dd/ r
MG
inches
m
-
m
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM E\'ENT CHARACTERISTICS:
Date 02-18-2014
Total Event Precipitation (inches): 0 . 2
Event Duration (hours): (only if applicable- see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable - see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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, accur e, and complete. I am aware that there are significant penalties for submitting false information,
includin" ossibility of fines and impr' onment for knowing violations."
(Sign re f Permittee) ( ate
Form SWU-247, last revised 21212012
Page 2 of 2

FEHR GFUJ-1'�M
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7013 0600 0001 5291 0759
RETURN RECEIPT REQUESTED
March 17, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, INC 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - February 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, INC 27870
NCS000325
® Dear Sir/Madam:
a
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
awater discharge from the above -referenced facility for February 2014.
v
Please note the following:
• Storm water samples were collected during a representative storm event on
February 18, 2014.
• The result for Zinc is above the facility's permit benchmark for outfall 001 only. The
facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
4^'-�'d pa,�J
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:ctd
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\14-105\Final\BJP 14-105 - Storm Water SDO February 2014 Cover Letter.docx
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

:r
;4
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
PermitNumbeENCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S)Marlo Carter
CERTIFIEDLABORATORY(S) Pace Analytical Lab# 40
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(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.)
rntrrts Halifj
ISIGNATURE OF PERMITTEE OR DESIGNEE I
REOUIRED ON PAGE 2.
'®
its I
' ,
®_®
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes Xno
(if yes, complete Part B)
Part B: Vehicle Maintenance Ac ivity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPII
(Method 1664
SGT-IIEM), if
appl.
Total
Suspended
Solids
pH
,
New Motor
Oil Usage
mo/dd/ r
MG
inches
mgA
mg/1
unit
al/mo
Form SWU-247, last revised 21212012
Page I of 2
rt .

I;00W
T�
STORM EVENT CHARACTERISTICS:
Date O1/10/14
Total Event Precipitation (inches): 0 . 09
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Toted Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
NI ail Original and one copy to:
Division of Water Quality
Attn: Central Piles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with it
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, lie, accurate, and complete. 1 am aware that there are significant penalties for submitting Else information,
including thebilit�of fines and imprisonment for knowing violations."
a eo— a v<y
(Date)
Form SW U-247, lust revised 21212012
Page 2 of 2

F E H R GR�`.�,'�M
ENGINEERING & ENVIRONMENTAL
CERTIFIED MAIL NO. 7013 2630 0002 0131 6254
RETURN RECEIPT REQUESTED
January 31, 2014
Division of Water Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - January 2014
Patch Rubber Company
100 Patch Rubber Road
Weldon, INC 27870
NCS000325
® Dear Sir/Madam:
X
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
Qwater discharge from the above -referenced facility for January 2014.
v
Please note the following:
Storm water samples were collected during a representative storm event on January
10, 2014.
The result for Zinc is above the facility's permit benchmark for each outfall. The
facility has already implemented its Tier 2 response, and will continue monthly
storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
Brian J. Paluzzi, P.G.
Project Environmental Scientist
BJP:cId
Enclosure
cc: Marto Carter, Patch Rubber Company
0:\Patch Rubber Company\14-105\Fina1\BJP 14-105 - Storm Water SDO January 2014 Cover Letter.docx
200 Prairie Street I Suite 208 1 Rockford, IL 61107 1 p:815.394.4700 I f:815.394.4702 I www.fehr-graham.com
Insight. Experience. Results.

w <�e
�e r
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director
Secretary
November 29, 2010
Mr. Mario Carter
Patch Rubber Company
P.O. Box H
Roanoke Rapids, NC 27870
Mr. Brian Paluzzi
Fehr -Graham & Associates
1920 Daimier Rd.
Rockford, IL 61112
� V�L 0 g 7010
Subject: Tiered Response to High Zinc Results in
Stormwater Sampling
Patch Rubber Co.
Permit No. NCS000325
Roanoke Rapids, NC
Halifax County
Dear Mr. Carter and Mr. Paluzzi:
At the invitation of Patch Rubber, I met with four representatives of the company and two Fehr -Graham &
Associates consultants on November 17, 2010 to review the efforts made by the company to remedy
consistently high zinc analytical results. The two outfalls have shown results consistently above the
benchmark target of 0.067 mg/I in the stormwater permit. A concise summary of the analytical data and
steps taken in recent months to identify the source of zinc was provided for our discussion. This information
showed that Patch Rubber has followed the requirements of the permit by mounting tiered sampling and
investigative activities when triggered by test results exceeding the benchmark. After four failed monthly
tests, DWQ was called in for this consultation meeting. Comments and highlights of the meeting were these:
1. The company has terminated the use of a zinc slurry in the formulation of its rubber products.
2. A cleaning company was hired to do a thorough cleaning of the floor in the manufacturing section of
the building.
3. Sampling of Air Handler #2 (AH#2 on the spreadsheet) showed a very high value on April 21, 2010.
This discharges to Outfall #1 which is typically the higher of the two outfalls. This air handler is no
longer in use as of June 2010, so this source has been eliminated.
4. Sampling of two catch basins (identified on the site map), condensate from the south air handler, and
a laboratory release all were below the benchmark.
5. A portion of the roof is made of galvanized metal, so is a source going to Outfall #2. This Outfall
serves only the roof downspouts and lawn drains. A downspout sampling in September 2009 showed
very high levels of zinc.
North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection Phone [phone]
Internet: v .ncwaterquality.org 1628 Mail Service Center Raleigh, NC 27699-1628 FAX [phone]
An Equal Opportunity/Affirmative Action Employer— 50 % Recycled/1 0% Post Consumer Paper
N''one
�r hCarolina
Jvrittrrall�
Customer Service
877-623.6748

Patch Rubber NCS000325 Consultation, November 17, 2010
V It
Page 2 of 2
6. A check has been made of the building construction details. Nothing related to zinc was discovered
by this inquiry.
7. The low level of the benchmark was discussed. It was explained that the level is set by numerous
scientific considerations.
Additional Steps Proposed by Patch Rubber
a. -Collect and test a sample of rainwater that has had no contact with the plant.
b. %JSpli?s`amples between two or more labs
!a. eContinue the search for sources.
..
b. L'ook=irito;methods (BMPs) for attenuating zinc in the stormwater. Two articles were provided
describing retention ponds where test show excellent removal of zinc. Ion exchange column
technology, use of activated alumina, and the effectiveness of dry plant leaves as filtering media,
especially walnut and poplar, were mentioned in a literature search.
c. I incorrectly stated that building a stormwater treatment unit requires an Authorization to Construct
from DWQ. The permitting group would like to review the plans, an informal action, but there is no
review by Construction, Grants and Loans Section as I had indicated. Simply communicate the
proposal to the Stormwater Permitting Unit.
d. A single sample upstream (of which outfall?) showed 0.03 mg/l, almost half of the benchmark.
Additional upstream sampling may give a better feel for background levels, especially as related to
the next point.
e. DWQ was asked how many other permittees have the Zn parameter. The permitting group agreed to
provide this information, which will be forwarded as soon as it is available.
It was noted that consultant Daniel Steohr is leaving Fehr -Graham, so the project will now be directed by
Brian Paluzzi.
If you have comments or corrections regarding the meeting, please let me know. As your investigations
progress, I look forward to further communications. Freely contact me at 919-791-4255 or
[e-mail].
Sincerely,
4 Myrl . Nisely
Environmental Chemist
Surface Water Protection Section
cc: RRO/SWP file
Central Files
SWPU, Atm. Ken Pickle

0.076--*%L
.'r�'" .
3? s --W
'7127Aq
0, 7 64 'r
ir/i-il,
0, �78 it
lined air her
0 029 mg/L
0.050 mg/L
t
!
Notes:
Stoan water permit"Benchmark" for Zinc is 0.067 mg
Samples were collected 3.30.10 after a period of
precipitation. No precipitation during sampling.
Zinc levels in catch basins may be elevated due to
E3 0
concentration as water accumulates in pit.
No discharge at Outfall 001. No sample collected
Air handler a2. 2.90 m91L
Air handler lit services the Calendar Lines.
Air handler for Banbury 103) not in operation. No sample
Air handlers discharge directly to Oudall 001.
B
�
Comments:
c
❑
No surprise that an air handler is a large source of zin,
a
�,...
However, I didn't expect Calendars to be a source for
zinc.
c
Internet outfal (water tap in
Zinc in catch basins and Outfall 002 indicates storm
o
Lab). 0.017 mg/L
water run-off from roof and/or airborne dust are sours
zinc as well as air handlers.
It appears that zinc level decreases as 9 progresses
through catch basins to OF002.
c-.
Zinc in drinking water is only 0.050 mg7L less than I
Perri benchmark
J��c nFarG. z7, o&,7
-
7 a� d2 23­
:etch
basin a4.
0.040 ni
..�... _. 002,
South air handler. 0 041 myL
b
0027 mgfL'
t,3 4
�.26 '
=la
lob r
i
Kennamelal Road
1 Laser Cutter Stacks
10 Band Heating Area
2 OiMater Separator
11 10,000 GAL Hydrotreated Naphthenic Oil
3 Storm Water Outfall 002
12 Propane Tank
..- 4 Storm Water Outfall 001
aseyQmaw" SamphPow
13 Banbury Dust Collector
14
6 Trash Compactor
Empty Containment Structure
15 Tank Farm'
7 Trash Rolloff
16 Tank Farm Unloading Area W1 Containment
6 Tape Line Stacks
17 Tank Farm Unloading Area Containment Drain Valve
9 Used Oil Storage Building
i6 Tank Farm Unloading Overflow Containment
' - 1 x 10,000 GAL Heptane
- 2 x 5,000 GAL Hisptania
1
-2 x 2,000 GAL Cleaner Fluid
J

Patch Rubber Company
Summary of Storm Water Analysis
Date of Sam tin Event: 6.5.09
Date of Sampling Event: 9.17.09
Date of Sampling Event: 2.25.10
Date of Sampling Event: 3.30.10
Date of Sampling Event: 4.21.10
Not reported. Resam led.
FGA/Patch collected for
FGA/Patch collected for
Outfall/
Reported as Bench n ,k E.... donce
reference on l . Not re ortetl.
reference ant . Not re orted.
Reponvcl as Benchmark e.....Wen,
r'
Location
zinc, total zinc, total
H COD m /1
( ) (m /l) H COD(mg/l (m0/ll
O
E
zinc, foul
Zinc, total
Zinc, total
Permit
pH
COD(, /0
mg/0
H
COD m 11)
(m /I
pH COD mg/l)
(moll)
Samples:
%
o
0
io
.o
m
_
io S
001 North
.1
1 14.8
10.078
6-34
10
0.796
002 South
.2
0.253
6.21
10
0.247
6.3
49.6
0.184
Atlditional
0.027
7.7
2D
0.984
Samples:
m
m
a
m o
0 ,
n
Downs out
6.16
10
Upstream
6.04
10
.5
0.031
North AH
0.026
0.029
Condensate
a
3
m
n
'
0
AH #2
Catch Basin #1
2.9
Catch Basin #4
0.05
Lab Tap
0.04
South AH
0.017
Condensate
3
0.041
Date of Sampling Event: 5.18.10
z
y
O
fD
O �
c
'
Date of Sampling Event: 7 27.W
z
m O j o
y 3
..
Bag
g o A n
n iD
3 o g
.w '+ _
roe
o
p
0 0
w 3
I =
>
'c
Date of Sam lin Event: 10.14.10
(zj ry
O g
mm
E
' n =
0 v
-
Re ortetl as Benctunark it va0e.ce
Outfal#Lowtio
R
Permit
H
COD (m /l)
Zinc, total
(m l0
Reporletl as Bentama,k Eacep4ance
Re rtbe as Benchmark ExLeedence
H LOD (m lq
2inQ
total
(m /0
pH COD (mg/0
Zinc, total
(m /q
Samples:
7
001 North
6.55
90.4
002 South
8.01
14.4
,325
0.034
128
0.786
7,65
7.65
24.5
0.678
6.24
22.4
0.208
10
0.108
Permit Benchmarks
H
COD
m l
Zinc, total m l
5-9 1
120
1 0.067
BoldlUnde_riine Indicates eaceedence of Permit benchmark
Please note:
Refer to Section B of the facility's NPDES Storm Water Permit for guidance on sampling requirements and Tier One/Tier Two requirements
Joe Mosher and Annette Johnson are trained to collect monthly storm water samples with assistance from Marla Carter. They also complete Qualitative Monitoring Report FGA coordinates
delivery of sample containers from TriTest and provides chain with FGA sample #. TriTesl bills FGA.
Storm water report (SDO) must be submitted no later than 30 days from receiving analytical report. Don't submit reports or Qualitative Monitoring Report_
QMR must be completed even if no "representative storm event".
Refer to Tier Two response file folder for facility's response actions.
ti

Compliance Inspection Report
Permit: NCS000325 Effective: 05/01/09 Expiration: 04/30/14 Owner: Myers Industries
SOC: Effective: Expiration: Facility: Myers Industries -Patch Rubber
County: Halifax Sr 1729
Region: Raleigh
Roanoke Rapids NC 27870
Contact Person: Marto Carter Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 11/17/2010 Entry Time: 08:55 AM
Primary Inspector: Myrl Nisely
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: Stormwater Discharge, Individual
Facility Status: ❑ Compliant ® Not Compliant
Question Areas:
E Other
(See attachment summary)
Exit Time: 09:48 AM
Phone: [phone]
Inspection Type: Technical Assistance
Page:1

v
Permit: NCS000325 Owner - Facility: Myers Industries
Inspection Date: 11/17/2010 Inspection Type: Technical Assistance Reason for Visit: Routine
Inspection Summary:
Following the Tier 1 and then Tier2 requirements in search of why zinc analyses were above the benchmark level of 0.067
mg/I, the company contacted DWQ for consultation once 4 monthly samples showed exceedences.
See the cover letter for full discussion of the meeting and future steps to be taken.
Other
Comment:
Yes No NA NE
Page: 2