NCG180256_NOI Application_20170417

Is 0
KEWAUNEE
Scientific
Corporation
4-11-17
Stormwater Permitting Program
Division of Energy, Land and Mineral Resources
1612 Mail Service Center
Raleigh, NC 27699-1612
RE: Permit Status Change - Kewaunee Scientific Corporation
To Whom It May Concern:
This letter is in response to conversations with DEQ that advised Kewaunee to apply for NCG18 status
based on suiting our manufacturing operations more appropriately. In addition, we are requesting a
rescission of NCG030087. DEQ advised that no fee would be necessary because the annual fee for our
current permit was recently paid and covers this year's billing cycle through 2018. Please see attached
both NO[ and Rescission forms.
Also attached is monitoring data from the past 3 years. This includes sampling at our outfalls, roof
downspouts and other locations as indicated. Sampling resulted in benchmark exceedances in pH and
zinc. Per permit requirements, we implemented actions for both Tier 1 and Tier 2 including but not
limited to: Research into possible causes, more frequent inspections of the property, cleanup of outside
materials, awareness training for all Associates, drain inserts in selected areas and painting of selected
galvanized duct work. Non process sources have been identified including galvanized fencing, ductwork
and guttering along with receiving runoff from a neighboring manufacturing facility.
Our resin dust was sampled for zinc content with results of 1.6 mg/kg. A new enclosed hopper was put
in place to improve housekeeping when unloading our dust system collector.
We also had conversations with local manufacturers that are under the same or similar permits. At least
3 of them indicated they also had exceeded some parameters including zinc.
As discussed with DEQ personnel, we feel the NCG18 status would better suit our manufacturing
operations and we greatly appreciate your consideration.
Please let me know if you have any questions or need more information.
Sincerely,
-�
Scott . Hager, CSP
Safety and Environmental Manager
Kewaunee Scientific Corporation
2700 West Front Street
Statesville, NC 28687
704-871-3238
[e-mail]
RECEIVED
APR 18 2017
DENR-LAND QUALITY
STORMWATER PERMITTING
PO BOX 1842, STATESVILLE, NORTH CAROLINA 28687-1842 • 2700 WEST FRONT STREET, STATESVILLE, NORTH CAROLINA 28677-2927
PHONE [phone] • FAX [phone]

FOR AGENCY USE ONLY
10, Date Received
+ * • Division of Energy, Mineral, and Land Resources Year Month Da
Land Quality Section Certificate Covemge
NCDENR National Pollutant Dischar g Y Ce Elimination System N C G
Check # Amount
�-
YptTH C�(3L11YA DFYFXIMEYr'OF
ENvino4mrrr nNn Narcra. F:Wsw%cm Permit Assi ned
NCG180000
NOTICE OF INTENT / IC 0 g 7
National Pollutant Discharge Eliminatio ystem application for coverage under General Permit
NCG180000:
STORMWATER DISCHARGES associated with activities classified as:
RECEIVED
SIC 25 Furniture and Fixtures, and SIC 2434 Wood Kitchen Cabinets, APR 18 2017
And, Like activities deemed by DEMLR to be similar in the process, or the exposure of raw
materials, products, by-products, or waste materials. DENR-LAND QUALITY
STORMWATER PERMITTING
* Standard Industrial Classification Code
(Please print or type)
1) Mailing address of owner/operator (address to which official permit correspondence will be mailed):
Name Kewaunee Scientific Corporation
Street Address Po Box 1842
City
Telephone No.
E-mail address
Statesville State NC ZIP Code 28687
704 873-7202 Fax: [phone]
[e-mail]
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Kewaunee Scientific Corporation
Scott Hager
2700 West Front Street
Statesville State NC
Iredell
704 871-3238
3) Physical Location Information:
Fax: 800
ZIP Code 28677
932-3296
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). 140 East, Exit 148. Take right on 64/90 .
Take left on Front Street and facility is on the left.
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted tooth this application)
4) Latitude 35 47' 39 ° Longitude 88 55' 56" (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
® Existing
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 3 8 2 1
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: Wood, Metal and Epoxy Resin laboratory furniture manufacturing
Page 1 of 4
SW U-233-82814 Last revised 8/28/14

NCG180000 N.O.I.
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 3
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Third Creek
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
10) Does this facility have any other water quality permits?
❑ No
P9 Yes
If yes, list the permit numbers for all current water quality permits for this facility: IUP 3009
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
El No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
13 Yes
If yes, please briefly describe
removal operations.
Regular inspections, housekeeping, enclosing dust
drain inserts and
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
C2f Yes
If yes, when was it implemented? 2008
14) Are vehicle maintenance activities occurring at this facility?
E3 No' ❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
0 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
Cf No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
❑ No E3 Yes
Page 2of4
SWU-233-82814 Last revised 8/28/14

NCG180000 N.O.I.
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Various flammable materials - waste stains from finishing.
Metal 55 ciallon
Where is material stored: An enclosed and bermed storage area
How many disposal shipments per year: 12
Name of transport / disposal vendor: Giant Resource Recovery
Vendor address: 755 Industrial Road Sumter, SC 29150
16) Certification:
North Carolina General Statute 143-215.6 b (1) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record,
report, plan or other document filed or required to be maintained under Article 21 or regulations of the Environmental
Management Commission implementing that Article, or who falsifies, tampers with or knowingly renders inaccurate
any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of
the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable
by a fine not to exceed $10,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001
provides a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both, for a similar
offense.)
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: Scott Hager
Title: Safety and Environmental Manager
(Signature of
4-11-17
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included.
Please do not ask us to hold an incomplete application in anticipation of a check under separate cover.
❑ Check for $100 made payable to NCDENR
❑ This completed application, signed by the owner/operator, and all supporting documents
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map
Mail the entire package to:
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note: The submission of this document does not auarantee the issuance of an NPDES permit.
Page 3 of 4
SWU-233-82814 Last revised 8/28/14

NCG180000 N.O.I.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
To visit our website, go to http://portaLncdenr.org/weblirlstormwater
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
707-9220
Page 4 of 4
SWU-233-82814 Last revised 8/28/14

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'T� • Division of Energy, Mineral & Land Resources
�r Land Quality Section/Stormwater Permitting Program
RCDENRNational Pollutant Discharge Elimination System
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
RECEIVE®
APRelf
Please fill out and return this form if you no longer need to maintain your NPDES stormwater perrO&R_LAND QUALITY
) E t th 't b t h' h th' r t o lies• STORMWATER PERMITTING
n 1is
er a perms nm uer o w is e11 pp
Individual Permit (or) Certificate of Coverage
N I C I S I I I I I N I C I G I o 1 3 1 0 1 o 1 a 1 7
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Kewaunee Scientific Corporation
Scott Hager
2700 West Front Street
Statesville State NC ZIP Code 28677
Iredell E-mail Address scotthagerCkewaunee.com
704 871-3238 Fax: [phone]
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on-) . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials
❑ Facility sold to I I on . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
® Other: We are attempting to change permit categories to better suit
our manufacturing operations.
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
Signature
Scott Hager
Print or type name of person signing above
Please return this completed rescission request form to:
Date
4-11-17
Safety/Environmental Manager
Title
NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] FAX: [phone]
An Equal Opportunity 1 Affirmative Action Employer

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2 0 / Y,
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCGQ12®❑0 ®❑?
This monitoring report summary of the calendar year should be keptonfile on -site with the facility SPPP.
Facility Name: /� e w a ill-7 c Z �c ��, �� f� c C �v p/�1/ fi 012
County:
Phone Number: 7( o 71 3 2 3,P Total no. of SDOs-monitored
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes E3*' No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes Rr No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other I ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No d
Total
Rainfall,
inches
Parameter, (units)
_' ,f;{y
B_ ` `"m- rk:
1 _ . � iS c
�-� �N%A„
>r/,a.
-..',r ,;�
=071=' � :
F _ x� .✓ 7
�• „ice
6�: r f,.,
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; ,b, f a
_ 'i' .�•
rQ„/',
::.a^"��:.i.�
..0.
.i,, r�,
4... �`'
';,.;,,>, ,�'�i•w-avi.•rr,-i
_
.,��• _`�'r �:
_
Date Sample
Collected,
mmiddlyy
~0 - -
-
5-
5
0
5.7
, t915
P�
-1Z
S�
/-
- 5 00.5
.00 2'
It
7,P
SW U-264-Generic-13Dec201

r,
Additional Ouffall Attachment
Outfall No. y-
Is this ouffall currently in Tier 2 (monitored monthly)?
Was this ouffall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other F1
Was this SDO monitored because of vehicle maintenance activities?
Yes No n
Yes No F1
Yes E] No 2--"
13knCfini*r
Total
Rainfall,
inches
No
Parameter, (units)
Z-Cad
2,/-/7C
F
Date Sample
Collected,
mm/ddlyy
—6,7 ;iE
302
0 0,5 zf-
SWU-264-Generic-1 3Dec201

Additional Outfall Attachment
Outfall No. 3
Is this ouffall currently in Tier 2 (monitored monthly)?
Was this ouffall ever in Tier 2 (monitored monthly) during the past year?
If this ouffall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other F1
Was this SDO monitored because of vehicle maintenance activities?
Yes 2--*"No E]
Yes P-'No El
Yes Fj No
Total
Rainfall,
inches
Parameter, (units)
-5
Z- ed
7-1-4,
" 70 /0"'
JVMl
Date Sample
Collected,
mmidd/yy
IT
�'-5 -tq-
57
F
1 o66
if 00 7
12-7
r3
&
Lty-
01) Of-
17
5,
SWU-264-Generic-1 Mec201

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 imprisonrrye_nt for knowing violations."
Signature
Date -
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHE_ VIL_L_-E REGIONAL OFFICE
FAYETTEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE_
WASHINGTON REGIONAL OFFICE
-�
WILMINGTON REGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
- -- --- --
[phone]
[phone]
WINSTON-SALEM REGIONAL OFFICE
CENTRAL OFFICE'
------------------------------ - --- ----
585 Waughtown Street
1617 Mail Service Center
"ro preserve. protect
Winston-Salem, NC 27107
Raleigh, NC 27699-1617
and enhance
[phone]
[phone]
North Carolina's ►vater..."
SW U-264-Generic-13 Dec201

Individual NPDES Permit No. N
Certificate of Coverage (COC) No. N
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2 D /5
or
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: c e- „�C � Cf'1 1 / i s CCU 0 ra I'i Dn
County: t111 2
Phone Number: ( 70(f1 �7� ` %%��'� Total no. of SDOs monitored -�
outfall No.
Is this outfall currently In Tier 2 (monitored monthly)? Yes z`No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes Yr No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Total
Rainfall,
inches
Parameter, (units)
"Tss
X//
2 /�'JG
n n�o1a/
6
Benchmark
N/A
^0 L
G^ —
r 00 7
3
a C) C 7
S
DateSample
Collected
tumidd I
1.
'
-
•'f
:J a
:1 ar
:a-
--r.
f
_
F
?ei•`
776
0252-
, o0a5
. 3/
%
SW U-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes No ❑
Yes No ❑
Yes ❑ No
Benchmark
Sample
Colle 7
mm/d7dI' �
Total��
Rainfall,
Inches.
; IA
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SW U-264-Generic-1 Mec2012

Additional Outfall Attachment
Outfall No. :7
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency F-1
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes P-'-'N-o EJ
Yes Q.-'No F1
Yes E] No 9--�
Total
Rainfall,
Inches
Parameter,(units)
A'e 10f-
Benchmark
Date Sample
Collected
mm/ddTl7
NIA
z
OW15
7—(715
2
-G, 330
5
oo 25
i 9if-
12*-1-5;
2-Y-i 17
9/
002-S
2- 93
SWU-264-Generic-1 3Dec2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2 d /.d
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG® 3❑00❑FZ_1
This monitoring reportsummary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: ke'-.VVaVt)ec Ci G/7 f i f C (fl)c'91-0 ' l00
County: rt k c
Phone Number: (� 2 Total no. of SDOs monitored :,->
Outfall No. i/_Q — Ao" f t9r'41'
,) ir?�infci� c� E�
Is this outfall currently in Tier 2 (monitored monthly)? Yes­E3---Nr-f]
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yeses
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yew❑ rem
Total
Rainfall,
inches
Parameter, (units)
G,
Benchmark
N/A
Date Sample
Collected,
mm/dd/yy
SW U-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. %VA - /I 0 0 � 0r4 /) o'; "Q 1? aclh ti7 c ✓�u�f�,
Is this outfall currently in Tier 2 (monitored monthly)?B—
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes 8—fdo-8"
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes-E+--MTM—
Parameter, (units)
Total
Rainfall,
inches
Benchmark NIA —
Date Sample - - - -
Collected,
mm/dd/yy • a
0 LT
SW U-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. —4 ` �/��Q 6 n! SA/Igg �'0 0 a)
Is this outfall currently in Tier 2 (monitored martfhly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
I ulrw��'
Total
Rainfall,
inches
Parameter,
(units)
/
tia.,F•'yiJ"I FSC'�'P 'jr
r.�„Y � 4„�- �:�:-�� �
r t.t .+�:...nt� �. rr
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,
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w.rr.h 1I--r.it �;,.i:'Y;.$4. 'S:i
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Benchmark
Date Sample
f"
Collected ,
mm JddJYY
`�`
6 NIA
i° T �. h
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SW U-264-Generic-13Dec2012

" 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 imprisonmerltfor knowing violations."
Signature ,_
Date 2-'
For questions, contact your local Regional Office:
DWO Regional Office Contact Information:
A_SHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
ISTON-SALEM REGIONAL OFFICE_
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
FAYETTEVILLE REGIONAL_ OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE__
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
To preserve. protect
and enhance
No" )III Carolina's Ivater..."
SW U-264-Generic-13 Dec2012

A
Individual NPDES Permit No.
Certificate of Coverage (COC) No.
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2 W
or
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: 6 bvd v n .0 SC-1 e17 f / �C ti L9i7
County:
Phone Number:
3.z
r
Total no. of SDOs monitored
Outfall No. os zr, `' yDC Q % ID bv�r orl-- gr arev
Is this outfall currently in Tier 2 (monitored monthly)? Yeses---Nb-M
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes.®_A4e-e
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes'Ei--M-E]
Total
Rainfall,
inches
Parameter, (units)
%S.
'
,TO,, ,'o %r
V-
Benchmark
N/A
QQ
—
, QQ %
, 03
06
5
Date Sample
Collected,
mm/dd/yy
-
9 S
2Y7 Z
T. 7
,c, 03
00 25
5
SW U-264-Generic-13Dec2012

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
Date �--(O-/
For questions, contact your local Regional Office:
DWO Regional Office Contact Information:
2090 US Highway 70
Swannanoa, NC 28778
[phone]
R_ A_ LE_IGH REGIONAL OFFICE E
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SA'LEM_REGIONAL OFF
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
iLMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To presence. protect
and enhance
North Carohna's Water..."
SW U-264-Generic-13Dec2012