NCS000592_MONITORING INFO_20180607

---—STORNIINATER'DIVISION-CODING-SHEET
PERMIT NO.
NCC OHO
DOC TYPE
❑ FINAL PERMIT
% MONITORING INFO
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ Zal U Ob a-i
YYYYMMDD

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Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on f lling out this form, please visit https:/Idea.nc.gov/about/divisions/energy-mineral-land-
resources,'eneriy-m i nera l -land-permits/stormwater-permits%nodes-industrial - sw#tab-4
Permit No.: NICI�SI b10101�112/ or Certificate of Coverage No.: N/CIGI 1l 1_I 1_l
Facility Name: &A MP4 O� R A .P
County: a ►•}-AS[ Phone No. 2 - Sb-1 w !a 076
Inspector:
Date of Inspection:
Time of inspection:
Total Event Precipitation (inches): W fl RECEVED
All permits require qualitative monitoring to be performed during a "d3WdftrSW7K1@jM event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during; the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permitteelor Designee?
1. Outfall Description:
Outfall No. 1 Structure (pipe, ditch, etc.): r` te��,� a AQCA.
Receiving Stream: t t\
Describe the industrial a tivities that occur within the out all drainage area:
�'agAA;� L)da -sv��— 910�.
R t�
Page 1 of 2
SWU-242, Last modified 07/28/2017

f
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint z
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
`.:J 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy-
2 3 4 5
7. Is there any foam in the stormwater discharge? O Yes ft No.
8. Is there an oil sheen in the stormwater discharge? OYes • No.
9. Is there evidence of erosion or deposition at the outfall? O Yes a No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe s--
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 07/28N2017

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS b00SRZ,
FACILITY NAME L'a t,- &\ R, r
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S).ivi # z,1
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 71<211117
(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 i�
PHONE NO.'(75ZX)--
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
:(
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Collected.
+TY
Total s
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Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes •✓no
(if yes, complete Part B)
Part K: Vehicle Maintenance
uirements
Form SWU-247, last revised 21212012
Pagel of 2

r"�aASTORM EVENT CHARACTERISTICS:
Date 0$ 7 119 t
Total Event Precipitation (inches): 1
Event Duration (hours): Ig jApS (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."
O
(Signature of Perm ttee) (Date)
Form SWU-247, last revised 21212012
Page 2 of 2

"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 N
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
G� Q
225 Green Street -
610 East Center Avenue/Suite 301
2090 US Highway 70
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
910 433-3300
o
3800 Barrett Drive
o
0
127 Cardinal Drive Extension
943 Washington Square Mall
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
585 Waughtown Street
Winston-Salem, NC 27107
1617 Mail Service Center
Raleigh, NC 27699-1617
.TOE PrMVd
andenhaese��w,�
336 771-5000
919 807-6300
- Is 't I
SWU-264 - Generic Annual DMR
Last revised 5/17/2013

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)1 SPPP Annual Update DATA REVIEW FORM
Calendar Year 2011K
Individual NPDES Permit No. NCS[N[ ❑c QN© or
Certificate of Coverage (COC) No. NCG❑❑❑❑❑❑
This monitoring report summary of the calendar year should be kept on rile on -site with the facility SPPP.
Facility Name:
County: lti-U i A?c
Phone Number: t"!L c7
Total no. of SDOs monitored Z
Outfall No. I - -
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No [
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ 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)
13op �-
'-.aDI LR�[.
M i L" ,
k eVA,
L..►.r'orM�w�i
L , _
L
Benchmark
Date`Sa"ihole
Collected,
mmidd/yV ,,
NIA
3o
0
17,d 0.3y
a.90S
O - O 1O
1 O p
(p
-Z_ 1B
-A`;
LALAOo01rj
O.d11
0.3Sa
SWU-264 - Generic Annual DMR
Last revised 511712013

Additional Outfall Attachment
�utfall No. X
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No [�
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ 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)
(?yip L
C'oD 1L
ANSV;,4e-
M j t—�
4rR.oMikx
i---
�c
T`55
Benchmark
Date Sample
Collected,
mmlddtyy
I N/A
VZO
O Z14
0.9D$
O.Otfl
f00
(,
LZ.o
Co. cro5
co.Oc�s
01 OAS
6.9
SWU-264 - Generic Annual DMR
Last revised 5/17/2013