NCG030669_MONITORING INFO_20181018

STORMWATER DIVISION CODING SHEEP
' NCG PERMITS
PERMIT NO.
DOC TYPE
❑HISTORICAL FILE
-j4,_j1AONITORING REPORTS
DOC DATE
❑ a%SIX Ili I X
YYYYMMDD

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG03 D & G 9
FACILITY NAME A G r` O T y oruEL S o 4 u T/O 1V5
COUNTY RO WAN
PERSON COLLECTING SAMPLES RO ER T WCA/S t J: Y
LABORATORYP4CE' A�VdLyr1cA4 LabCert.# NG dW 377/2
Comments on sample collection or analysis: NC 1%W d 37706
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR (20 /
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout []PNA
WW elf* p ❑Zero -flow ❑Water Supply []SA
Wy *P— nn ❑Other
RECEIVE L[)PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -�
NOV 0 9 2018
CENTRAL FILES ❑ No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organlcs5
Benchmarks ===>
_
-
100 mg/L or 50gmg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
16
10 10 l8
�• 30
5. % `�I�L
?. 2 t
ac�l,?2
<• Od5 /c
m
p
<'o-'. 8 �J
(o bo i8
r. 3v
< 2.5 MY -A
-7. 32
t'.005f L
<.005m3
<-010
< 4,8"'-Y/
' 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.
"See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total 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 46931).
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3 �� �\�\`,b

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so 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."
RON I?. RicIyIflzp
Name (Print name)
Fq C It l7Y A �V_O 1*1A(7EN1-NcF
T Ijrint itle)
( ignature)
M. ev.4czrq
It zt9 1g
(Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format. "<XX mg/O 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 B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
El No discharge this period?
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar 0&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.
Permit Date: 11/1/2012-10/31/2017
SWU-245, last revised 10/25/2012
Page 2 of 3

Note: If you report a sample value in excess of the benchmark, you must implement rer 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART 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 ANYONE 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 receipt of the lab resultslor 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 awate that then are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3
�q lta

` Semi-annual Stormwater Discharl~e Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted O (`p 2018
CERTIFICATE OF COVERAGE NO. NCG03 0 Co _G 9
FACILITY NAME AGiL l_rY ,DUEL SyLVTIONS
COUNTY Ro W-41V
PERSON COLLECTING SAMPLES OaFRT 46WS L EY
LABORATORY PACE 4N.41.Yr1C41-Lab Cert. B NC OW 37712
Comments on sample collection or analysis: NC DW #' 3'7 7 0 6
Part A. Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR (O (2O /ff
SAMPLE PERIOD ❑X Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
WK/4(40 ❑Zero -flow ❑Water supply ❑SA
REYOE,ri n ❑Other
JUL 2 0 2018 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
CENTRAL FILES
0WR SECTION ❑ No discharge this period?'
Outfall No.
Date Sam le
p
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organics
Benchmarks ==>
_
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
06 /Z'5118
0.27
5.-r V;/,L
7.36
<.O05 /<<-005M<.010
5.01hI/
;2
06126 /8
0.2 7
< . 5 '71
7. 5 S
< . o 05' ,
<. o 0S
<. o /o
5.0 `7/
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total 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
tune 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 may so 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 dFor 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."
t?o N R
Name (Print name)
R/ c414 RD
,4 c 1.4 / rY AN) M411V TEK,4 NcE
Ti e ( ink ti le)
(Signature)
a,4IVA GER
I6k B
(Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format, "<XX ms/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 B: 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 5o 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.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one cony, of this DMR, including all "No Discharge" reports, within 30 days of recut of the lab results for at end -of ,monitoring period
in the case of "No Discharae" 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 p rsons erectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am �war a that here are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re of Permittee)
b l'�
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

or 1
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG03 O 6 6 9
FACILITY NAME /a G t4 r Ty FUEL 50LUT/d A/S
COUNTY R0 W4 N
PERSON COLLECTING SAMPLES R0i7C1?t NENS44Y
LABORATORY PACE gNAt Yr " 111 Lab Cert. h NC p y✓ 377f2
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _ 5' (2 0 " 7)
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly'_ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
ww o ❑Zero -flow ❑Water Supply ❑SA
FAbVED ❑Other
1,!OV 14 2017 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
CENTRAL FILES
DWR SECTION
No dischorge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organics5
Benchmarks =_->
_
-
100 mg/L or 50 mg/L
6.6 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
Ism L
1 mg/L
18
ro 23117
2.40
< 5.0 '"y 4
6. 4
<,005"7/
<<o05
.010
.0 11,
2
7o/23/1y
z,fa
2,q "',$/c
.26
<,005^'�!�
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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.
S Total 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

N
Facilities that incorporate a solvent management plan into the 5tormwater Pollution Prevention Plan may so 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 5tormmwater Pollution Prevention Plan."
gov', e
Name (Print name)
I-VT4 WO�-
T e ( rint title)
(ignature) (Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format "<XX m 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 B: 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,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
-
-
15 mg/L
100 mg/L or 5o 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.
Permit Date: 11/1/2412-10/31/2017 5WU-245, last revised 10/25/2012
Page 2 of 3

Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART 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:
Mall an original and one copy o this DMR including all "No Discharge' reports. within 30 days of receipt of 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 TOR 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 pers s dir ctly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aw e t at th re are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date:11/1/2012-10/31/2017
( ate)
SWU-245, last revised 10/25/2012
Page 3 of 3

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted __0(2a Ig
CERTIFICATE OF COVERAGE NO. NCG03 0 Cn G 9 SAMPLE COLLECTION YEAR S 20 / T
FACILITY NAME 4 G /1-1 r Y FUEL 50-L U Ti 0 NS SAMPLE PERIOD QJan-June ❑ July -Dec
COUNTY /?0 WA N or ❑ Monthly' _ _ (month)
PERSON COLLECTING SAMPLES Roact? T I-le*AI5 LEY �,I MCHARGING TO CLASS ❑ORW ❑HQW [:]Trout❑PNA
LABORATORY PACE ANAt y r/ rA4 Lab Cert. P NC 0 37 7it¢16 ❑Zero -flaw ❑Water Supply [:]SA
Comments on sample collection or analysis:
JUN 2 8 2017 ❑other
Part A: Stormwater Benchmarks and Monitoring Results
CENTRAL FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -�
DWR SECTION
❑ No discharge this period?
outfall No.
Date Sam le
p
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar 0&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organicss
Benchmarks -__>
-
-
100 mg/L or 50 mg/L
6.0 - 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
06 11.3 r
0,60
< 5,0 11VA
7,67
<.005MY/
<5:v
2.
06/r3 17
0.60
3.3 m1
7.78
-C,065"°9%
<.005!JX
<,d/Om j.
<9.0 "'f' A
1 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.
5 Total 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

4
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so 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 Storrmmwater Pollution Prevention Plan."
1 0A.1 1 L t t�t►A QaC_1_
Name (Print name)
Ti le (PI L rint
ti
(Signature) (Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format "<XX mRIC, 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 B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
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.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS;
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS, SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS, SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one cony of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring period
in the case of "No 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 kat 4ere are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

�n ems' fcaJe
www.peommscom
June 26, 2017
Robert Hensley
Agility Fuel Systems
1010 Corporate Center Drive
Salisbury, NC 28146
RE: Project: Stormwater
Pace Project No.: 92344329
Dear Robert Hensley:
Pace Analytical services, LLC
9800 Kincey Ave. Suite too
Huntersville, NC 28078
[phone]
Enclosed are the analytical results for sample(s) received by the laboratory on June 15, 2017. The
results relate only to the samples included in this report. Results reported herein conform to the most
current, applicable TNIINELAC standards and the laboratory's Quality Assurance Manual, where
applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Wa' QAI , t$"
Angela Baioni
[e-mail]
[phone]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall nut be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 14

Pace Analytical Services, LLC
aceAnalytical a 9800 Kincey Ave. Suite 100
Hunlersville, NC 28078
078
com [phone]
CERTIFICATIONS
Project: Stormwater
Pace Project No.: 92344329
Charlotte Certification IDS
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
Asheville Certification IDS
2225 Riverside Drive, Asheville, NC 28804
Florida/NELAP Certification #: E87648
Massachusetts Certification #: M-NC030
North Carolina Drinking Water Certification #: 37712
South Carolina Certification #: 99W6001
FloridalNELAP Certification #: E87627
Kentucky UST Certification #: 84
Yrginia/VELAP Certification #: 460221
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
Virginia/VELAP Certification #: 460222
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Anatytical Services, L.L.C. Page 2 of 14

Pace Analytical Services, LLC
Q • 9800 Kincey Ave. Suite 100
/+��Huntersville, NC 28078
IC,
/WVW 8
wmpacelahs.oarn [phone]
SAMPLE ANALYTE COUNT
Project: Stormwater
Pace Project No.: 92344329
Lab ID Sample ID
Method
Analysts
Analytes
Reported
Laboratory
92344329001 OUTFALL 1B GRAB
EPA 1664B
JMS
1
PASI-C
EPA 200.7
SH 1
3
PASI-A
SM 2540D
MVC
1
PASI-A
92344329002 OUTFALL 2 GRAB
EPA 1664B
JMS
1
PASI-C
EPA200.7
SH1
3
PASI-A
SM 2540D
MVC
1
PASI-A
REPORT OF LABORATORY ANALYSIS
This report shall not he reproduced, except in full,
without the written consent of Pace Analytical Services. LLC. Page 3 of 14

aceftljftal
wrrw.p&0gW&mm
SUMMARY OF DETECTION
Pace Analytical Services, LLC
9800 Kinsey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: Stormwater
Pace Project No.: 92344329
Lab Sample ID Client Sample ID
Method Parameters Result Units Report Limit Analyzed Qualifiers
92344329002 OUTFALL 2 GRAB
SM 2540D Total Suspended Solids 3.3 m91L 2.5 06/19/17 11:D9
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 4 of 14

,�5a'cmnaljftale
w4mpsoealm cam
ANALYTICAL RESULTS
Project: Stormwater
Pace Project No.: 92344329
Pace Ana"cal Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Sample: OUTFALL 1 B GRAB
Lab ID: 92344329001 Collected: 06/13/17 19:20
Received: 06/15/17 10:20 Matrix: Water
Parameters
Results Units
Report Limit
DF
Prepared
Analyzed
CAS No. Qual
1664 SGT HEM, TPH
Analytical Method: EPA 16648
Total Petroleum Hydrocarbons
ND mg1L
5.0
1
06/21/17 06:24
200.7 MET ICP
Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Copper
ND ug1L
5.0
1
05/20/17 1525
06/24/17 05:03
7440-50-8
Lead
ND ug/L
5.0
1
06/20/17 15:25
06/22/17 06:27
7439-92-1
Zinc
ND ug1L
10.0
1
06/20/17 1525
06/22/17 06:27
7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
ND mg/L
5.0
1
06/19/17 11:09
Date: 06/26/2017 08:39 AM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 5 of 14

aceAnalytical
Oki wP mm
ANALYTICAL RESULTS
Project: Stormvrater
Pace Project No.: 92344329
Pace Analytical Services, L.LC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Sample: OUTFALL 2 GRAB
Lab ID: 92344329002 Collected: 06/13/17 19:40
Received: 06/15/17 10:20 Matrix: Water
Parameters
Results Units
Report Limit DF
Prepared
Analyzed
CAS No. Qual
1664 SGT HEM, TPH
Analytical Method: EPA 1664B
Total Petroleum Hydrocarbons
ND mg/!_
5.0 1
06/21/17 06:28
200.7 MET ICP
Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Copper
ND ug/L
5.0 1
06/20/17 15:25
06/24/17 0512
7440-50-8
Lead
ND ug1L
5.0 1
06/20/17 15:25
D6122/17 06-45
7439-92-1
Zinc
ND ug[L
10.0 1
06/20/17 15:25
D6/22117 06:45
7440-66.6
25400 Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
3.3 mg1L
2.5 1
06/19/17 11:09
Date: 06/26/2017 08:39 AM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services. L.L.C.
Page 6 of 14

(�IeAnalyfical"
tntrnpaatabs 0=
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92344329
QC Batch: 365744 Analysis Method: EPA 1664B
QC Batch Method: EPA 1664B Analysis Description: 1664 SGT-HEM, TPH
Associated Lab Samples: 92344329001, 92344329002
METHOD BLANK: 2027661 Matrix: Water
Associated Lab Samples: 92344329001, 92344329002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Petroleum Hydrocarbons mg/L ND 5.0 D6121117 06:15
Pate Ana"cal Services, LLC
9800 KinceyAve. Suite 100
Huntersville, NC 28078
[phone]
LABORATORY CONTROL_ SAMPLE:
2027662
Spike LCS
LCS
% Rec
Parameter
Units
Cont. Result
% Rec
Limits
Qualifiers
Total Petroleum Hydrocarbons
Mg/L
20 19.5
98
64-132
MATRIX SPIKE SAMPLE:
2027663
35318450001 Spike
MS
MS
% Rec
Parameter
Units'
Result Conc.
Result
% Rec
Limits Qualifiers
Total Petroleum Hydrocarbons
mg/L
5.OU 20
19.8
97
64-132
Results presented on this page are in the units indicated try the'Ur>W collator except where an attemate unit Is presented to the rtyM of the result_
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 06/26/2017 08:39 AM without the written consent of Pace Analytical Services, LLC. Page 7 of 14

(�IaceAnalyficato
rww'"celaGt:c=
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92344329
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 2807B
[phone]
QC Batch: 365547
Analysis Method: EPA 200.7
QC Batch Method: EPA 200.7
Analysis Description: 200.7 MET
Associated Lab Samples: 92344329001, 92344329002
METHOD BLANK: 2026517
Matrix: Water
Associated Lab Samples: 92344329001, 92344329002
Blank
Reporting
Parameter
Units
Result
Limit
Analyzed Qualifiers
Copper
ug/L
ND 5.0
06/24/17 04:48
Lead
Ug1L
ND 5.0
0612VI7 06:21
Zinc
ugfL
ND 10.0
06/22/17 06:21
LABORATORY CONTROL SAMPLE:
2026518
Spike
LCS
LCS % Rec
Parameter
Units
Cone.
Result
% Rec Limits Qualifiers
Copper
ug1L
500
517
103 85-115
Lead
ug1L
500
538
108 85-115
Zinc
ug/L
500
539
108 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2026519
2026520
MS
MSD
92344329001
Spike
Spike MS
MSD MS MSD
% Rec
Parameter
Units Result
Cone.
Cone. Result
Result % Rec % Rec
Limits
RPD Qual
Copper
ug/L ND
500
500 531
526 106 105
70-130
1
Lead
ug/L ND
500
500 524
521 105 104
70-130
1
Zinc
ug/L ND
500
500 526
523 104 104
70-130
0
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2026521
2026522
MS
MSD
92344662009
Spike
Spike MS
MSD MS MSD
% Rec
Parameter
Units Result
Cone.
Cone. Result
Result % Rec % Rec
Limits
RPD Qual
Copper
ug/L 2.7J
500
500 536
541 107 108
70-130
1
Lead
ug/L ND
500
500 497
500 99 100
70-130
1
Zinc
ug/L 5.6J
500
500 497
496 98 98
70-130
0
Results presentetl on this page are in the units Indicated by the "UnW 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: 06/2612017 08:39 AM without the written consent of Pace Analytical Services, LLC.
Page 8 of 14

BCEAfialjlt1C81 •
wnw.paoa4+hs.rmr
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92344329
QC Batch: 365415 Analysis Method: SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92344329001, 92344329002
METHOD BLANK: 2025974 Matrix: water
Associated Lab Samples: 92344329001, 92344329002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mglL ND 2.5 06/19/17 11:09
Pace Analytical Services, LLC
9800 Kinoey Ave. Suite 100
Huntersville, NC 28078
[phone]
LABORATORY CONTROL SAMPLE: 2025975
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Total Suspended Solids mg1L 250 240 96 90-110
SAMPLE DUPLICATE: 2025976
92344329001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg1L ND ND
SAMPLE DUPLICATE: 2025977
92344259017 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mglL ND ND
ResuRs presented on this page are In the units indkated by the'UnIts- Column except where an altemrte unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 06/26/2017 08:39 AM without the written oonsent of Pace Analytical Services, LLC. Page 9 of 14

Pace Analytical Services, LLC
d�+��� 9800 KinceyAve. Suite 100
�}�
Ce u ca Huntersville, NC 28078
www.pecalabacam
[phone]
QUALIFIERS
Project: Stormwater
Paoe Project No.: 92344329
DEFINITIONS
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-Diphertylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each anatyte 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 Acxytonitrile by EPA
Method 8260.
N-Nhrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI - The NELAC Institute.
LABORATORIES
PASI-A Pace Analytical Services -Asheville
PAST-C Pace Analytical Services - Charlotte
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full.
Date: 06/26/2017 08:39 AM without the written consent of Pace Analytical Services, LLC. Page 10 of 14

(�IaceArWcal*
mrwpa obscom
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Stormwater
Pace Project No.: 92344329
Pace Analytical Services, LLC
9800 Kincey Ave. Suits 100
Huntersville, NC 2807E
(704)875r9092
Lab ID Sample ID QC Batch Method QC Batch Analytical Method
92344329001
OUTFALL I GRAB
EPA 1664B
365744
92344329002
OUTFALL 2 GRAB
EPA 1664B
365744
92344329001
OUTFALL 1B GRAB
EPA200.7
365547 EPA200.7
92344329002
OUTFALL 2 GRAB
EPA 200.7
355547 EPA 200.7
92344329001
OUTFALL 18 GRAB
SM 2540D
365415
92344329002
OUTFALL 2 GRAB
SM 2540D
365415
Date: 06/26/2017 08:39 AM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pare Analytical Services, LLC.
Analytical
Batch
365747
365747
Page 11 of 14

Document Name:
Document Revised: Sept. 21, 201ii
•
Sample Condition U on Recei t SCUR
Page i Of 2
Document No.:
Issuing Authority:
r7C��ilI�S/f'ICcZa!
-
F-CAR 6-033•Rav,01-
Pace Quall Office
Laboratory receiving samples:
_.. , .. :...Asheville [Eden❑ Greenwood -I♦untersville-0 _ Ralelgh❑ Mechanicsvilie0
• Cilient. Name: W4#� : 92344329
Aq
� , o,ect Wei #: II I I 1 � II II III it III
Courier: Ex DUPS, OUSPSa C]CFe'nt
❑ Commercial ❑Pace / ❑Other: 92344328
Custody Seal Present? ❑Yeso .Seals Intact? �--}� ❑No i�jj 11 }}++
,_ ,� .�'�"' Datelinitials Pers.Leemil Con e"
Pacfdng Material: ❑Bubble Wrap bble Bags ❑None ❑Other:
Thermometer:
❑ iR Gun Il): Type } !c et ©Wue ❑None ❑Samples on Ice, cooling process has begun
Correction factor. Cooler Tern,, corrected IT Biological Tissue Froxen? ❑Yes " ❑Na L9m*—
Temp should be above Freezing to 6 C
USDA Regulated Soll ( [<A, water sample)
Did samples originate In a quarantine zone within the United States: CA, NY, or Sc (check maps)? old samples originate from a foreign source (Intemadonally,
❑Yes ❑No including Hawaii and Puerto Rico)? []Yes ❑No
Chain of Cus Present?
es
Na
N/A
A.
Samples Arrived within Hold Time?
es
No
N/A
2.
Short Hold lime Analysis 4 1n hr.)?
Yes
o
❑NIA
3.
Rush Turn Around Time Reg6ested?
©Yes
a
/A
4.
Sufficient Volume?
es
QN0
ON A
I S.
Correct Containers Used?
J24r -
[]No
©N/A
1 6.
Containers lr_•act?
21&
No
N A
7.
Samples Field Filtered?
QYes
No
LINIA
B.
Sample Labels MatchC0C?
es
QNo
❑NJA
9.
"'".1itciudesOate/Time/ID/Ana sis ' Matrfx'
"
Heads ace in V0A Vials >5-6mm}?
as
No
/A
]U.
Trip Blank Present?
❑Yes
(3No
NJA
11
Trip Blank Custody Seals Present?
DYes
No
/A
CLIENT NOTIFICATIONJRESOLUnON
r
Person Contacted:
Comments/Sample
Discrepancy:
Sediment is visible in the dtssoived container
Date/nme:
Field Data Required? Dyes []No
Project Manager SCURF Review: F 7 T T 1 Date: L Y I t t! I 11�Y1
Prefect Manager SRF Review: T i M - — Datel _ _ �` 1 " !
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form vAl he sent to the North Carolina DEHNR Certification office (Le.
Out of hold, incorrect preservative, out of temp, incorrect containers)
Page 12 of 14

w
0
4
3
ro
Q
e�6
0
v
i
W
m
x
0
a
A
ry
�
rt
.
�
n
3
�
n
.�F
�
O
V
A
3
ro
m
t1
Of
S
7
M.
w
4 '►
d
N
r
O
Q*
C%
uN
a
w
N
I
-Itnmtl
z7zzz—z
z
z
z
9P4U-I2S mL plastic Unpresenred (M/Al (C-1-1
ep3u.2S0mLPlastic Unpreserved I N/A)
RM 500 mL Plastic Unpreserved (N/A)
..�
BP1U.1 liter Plastic Unpreserved (N/A)
BP35.250 mL Plastic H2504 (pH <2) (Cf-)
BP39-250 mL plastic HNO3 (pH < 2)
BP32-750 rnL Plastic 7_N Acetate & NZOH (>91
zzzzzl
BP3C-250 mL Plastic NaOH (pH > 121 (Cl-)
WG W-Wide-mouttled Glass jar Unpreserved
AG1U-1 liter Amber Unpreserved (N/A) (GI-)
A162W2 liter amber HCI (pH < 2)
AMU-250ml.Amber Unpreserved(N/A)(C1-)
AG15.1 liter Amber H2504 (pH < 2)
A635-250 mL Amber H2SO4 (pH <2)
AG3A(DG3A)-250 mLAmber NH4Cl (NJA)(d-)
DG9H-W mLVOA HO (N/A)
VG9T-40 mL VOA Na2S203 (N/A)
VQ9U-40 mLVOA Up (N/A)
DGSP-40 mL VOA H3PO4 MA)
VOAK (6 vials per kit)-5035 kit (N/A)
V/GK (3 vials per kit)-VPH/Gas kit (N/A)
SPS'r_2Z5 ml.Swfile Plastic (N/A— tab)
SP2?250 mi. Sterile Plastic (NIA —lab)
BP3A.2S0 mL Plastic (NH2)2504 (9.3-9.7)
Cubitatnpr
VSQU-20 mL Scintillation vials (MIA)
GN
0 Me
r— i
zM
M

CHAIN -OF -CUSTODY 1 Analytical Request Document
The Chair>-OI-Custody is a LEGAL M.UMENT. All relevant fields must be O npleted acetwelOy-
SeclWrt A Section 8 Section C
R.qutmd 04M tntormaimn: R.Www Project Infam "M tmroics 1nlormadon: Pa 1 OT 1
Compary. AS*Irly Fuel Repon To. Bop Homl ArO^t °rc
Ad*vu: 1e10 CaTonft Carta Dfrm Cepy To: Cr>nrpanr Na",
Sstkbu , NC 28148
Andress:
RowIVArvAmmy
Emerl: rQ 614 1 = . GoM
PueduAa Order o:
Pete Quel.: .
Phone 7o
Pmjed NaMW SSarmwOw
Pam PmJw Mapper a a.baien' pacetabe.dxn, EH
. •• 41rM. FLocalian '
Ra"ff.A Dw Daw
Projad 0;
Pace Pro61e 0: 8161.2
NC
Ra
riled
Fi6erad
rN
-.
uaMu cool
U~v Yb1� ow
YWI. wr
W—ft—
f ." P
SAMPLE ID S.&S.'r U
Orte Chametor p.r bat NO. WWP
(Az 8�91, •t � ar
sarrtpw 10► rrad be urdque n— Te
=
it
8
3
V
(m
t7
w
COLLECTED
`a
Presetvatives
r
START
eNa
r
DATE
TwE
DATE
TWiE
• ,
rD U77--A L L 1 B G-RA$
�"'
6
�3/,
r9:z
✓
2 :
!U UTF�t �G 2 GR.f'
G
6
sir
r9:
✓
1.
:4
.s
e
T
'
s
9
1D
11
-
12
'ADDrn6NnLrODUBf>d
Rruuww vwUfIAMlATM ;
DAt, -
MAKE .
AccrEv FDerrAPa<ntAturN
DATA
; nMe
sAxPLBCONd11oNs
r ✓ �i6/c
(o L1t
7 !3 :
o 1 ✓1 G G
.
SAMPLM RAMH AND 5MMTDRE
PRINT Name of SAMPLER: pp j?C,13ea %
SIGNATURE of SAMPLER:
DATE Signed:
rI
v
0
v
4)
m
a

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG030 6 6 9
FACILITY NAME 11614 i 'rX fruC��'-
COUNTY /?0 WA N
PERSON COLLECTING SAMPLES __ i?013C RT r�ENS IL t= Y
LABORATORY i A C2' ANA i- Y i C4 L. Lab Cert. ti NC1 W 4�3 77 1,e . WW '.4 v
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 20 i c
SAMPLE PERIOD ❑ Jan -June .0 July -Dec
or ❑ Monthly' _ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout QPNA
❑Zero -flaw [:]waterSupply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -3
7 No discharge this period?'
Outfall No.
Date Sample
i
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organics s
Benchmarks
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
113
1 / z 116
o, 5,
rt 2. 5 "V/L
6.9
< 0. 005 $
<'v.005 • l
0.#.z4,,
< 5.0 ny%�
2
it%i//!�
U.��
7,9 AY/L
7.
<0.0oa,
0 0,05,11,<u,aio
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
° See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total 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 5WU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the 5tormwater Pollution Prevention Plan may so 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 5tormwater Pollution Prevention Plan."
/?UN OGI�41?_19
Name (Print name)
hifCILrTY r:ND &TAtNrrVAt-JC-E M-iNflGe:R
TNe (,rip title)
(Si nature) Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format, "<XX me/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 B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
Q No discharge this period ?2
outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar 0&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.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES 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 oriainal.and one cop +>r of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end oLmonitorina 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, un er penalty of law; that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure at alified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those p rson directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
ar>�aw th theZ-Pre significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date: 11/1/2012-10/31/2017
SWU-245, last revised 10/25/2012
Page 3 of 3

•
8C2AlTaIy�ICa1
*VW.P rafahaoom
December 07, 2016
Aaron Swartley
Agility Fuel Systems
1010 Corporate Center Drive
Salisbury, NC 28146
RE: Project: OILAND GREASE/METALS
Pace Project No.: 92321515
Dear Aaron Swartley:
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 1 oo
Huntersville, NC 28078
[phone]
Enclosed are the analytical results for sample(s) received by the laboratory on December 01, 2016.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual,
where applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Sarah Graham for
Angela Baioni
[e-mail]
Project Manager
Enclosures
REC'Ei V
EF
JqN 9 6 fl
Z017
'DwRZA
SSL F/LES
rroj
REPORT OF LABORATORY ANALYSIS
This report shall not he reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 14

Pace Analytical Services, LLC
aceMalytiCa a
9800 Kincey Ave. Suite 100
Huntersviire. NC 28078
www.pacsA s.com
i
[phone]
CERTIFICATIONS
Project: OIL AND GREASE/METALS
Pace Project No.: 92321515
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
South Carolina Certification #: 99006001
North Carolina Drinking Water Certification #: 37706
Ftorida/NELAP Certification #: E87627
North Carolina Field Services Certification #: 5342
Kentucky UST Certification #: 84
North Carolina Wastewater Certification #: 12
Vrginia/VELAP Certification #: 460221
Asheville Certification IDs
2225 Riverside Drive, Asheville, NC 28804
North Carolina Wastewater Certification #: 40
Florida/NELAP Certification #: E87648
South Carolina Certification #: 99030001
Massachusetts Certification #: M-NC030
VirginiaNELAP Certification #: 460222
North Carolina Drinking Water Certification #: 37712
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
wdhaut the written consent of Pace Analytical Services, LLC. Page 2 of 14

Pace Analytical Services, LLC
•
9800 Kinsey Ave. Suite 100
Huntersville, NC 28078
[phone]
SAMPLE ANALYTE COUNT
Project: OIL AND GREASEIMETALS
Pace Project No.: 92321515
Analytes
Lab ID Sample ID
Method
Analysts
Reported Laboratory
92321515001 OUTFALL 1 B GRAB
EPA 1664E
JMS
t PASI-C
EPA200.7
JMW
3 PASI-A
SM 2540D
MJP
1 PASt-A
92321515002 OUTFALL 2 GRAB
EPA 1WB
JMS
1 PASI-C
EPA200.7
JMW
3 PASI-A
SM 2540D
MJP
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 14

aceAnalytical
www.pwekbs.mro
Project: OIL AND GREASEIMETALS
Pace Project No.: 92321515
Lab Sample ID
Method
Client Sample ID
Parameters
92321515001
OUTFALL I GRAB
EPA 200.7
Zinc
92321515002
OUTFALL 2 GRAB
SM 2540D
Total Suspended Solids
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntessville, NC 28078
[phone]
SUMMARY OF DETECTION
Result Units Report Limit Analyzed Qualifiers
424 ug/L 10.0 12/03/16 21:30
7,9 mg/L 2.5 1210211611:33
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Without the written consent at Pace Analytical Servers, LLC.
Page 4 of 14

(�IacI Anal bal'
e rr-. doslffiacmr
ANALYTICAL RESULTS
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: OIL AND GREASEIMETALS
Pace Project No.: 92321515
Sample: OUTFALL IS GRAB Lab ID: 92321515001 Collected: 11/29/16 08:46 Received: 12/01/16 10:30 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Total Petroleum Hydrocarbons
ND mg/L
5.0
1
12/02/16 08:19
200.7 MET ICP
Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Copper
ND u911-
5.0
i 12/02116 22:40
12/03/16 21:30 7440-50-8
Lead
ND ug1L
5.0
1 12/02116 2240
12/03/16 21:30 7439-92-1
Zinc
424 ug/L
10.0
1 12/02/16 22:40
12J03116 21:30 7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
ND mg/L
2.5
1
12/02/16 1i:33
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/07/2016 10:13 AM without the written consent of Pace Analytical Services, LLC.
Page 5 of 14

;8'cleArWcal"
wwwpaoet1l) corn
1
ANALYTICAL RESULTS
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: OIL AND GREASE/METALS
Pace Project No.: 92321515
Sample: OUTFALL 2 GRAB
Lab ID: 92321515002 Collected:
11/29/16 16:45
Received: 12/01/16 10:30 Matrix: Water
Parameters
Results Units
Report Limit DF
Prepared
Analyzed
CAS No. Oual
1664 SGT-HEM, TPH
Analytical Method: EPA 1664B
Total Petroleum Hydrocarbons
ND mg1L
5.0 1
12/02/16 08:20
200.7 MET ICP
Analytical Method: EPA 200.7 Preparation Method: EPA 200.7
Copper
ND ug1L
5.0 1
12/02/16 22:40
12/03/16 21749
7440-50-8
Lead
ND uglL
5.0 1
12/02/16 22:40
12/03/16 21:49
7439-92-1
Zinc
ND ug1L
10.0 1
12/02/16 22:40
12/03/16 21:49
7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 2540D
Total Suspended Solids
7.9 mg1L
2.5 1
12/02/16 11:33
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/07/2016 10:13 AM without the written consent of Pace Analytical Services, LLC. Page 6 of 14

W lV ELI"a
ww weekba earn
QUALITY CONTROL DATA
Project: OIL AND GREASEIMETALS
Pace Project No.: 92321515
QC Batch: 339088 Analysis Method: EPA 1664E
QC Batch Method: EPA 1664B Analysis Description: 1664 SGT-HEM, TPH
Associated Lab Samples: 92321515001, 92321515002
Pace Analytical Services, LLC
9800 KinceyAve. Suite 10o
Huntersville, NC 28078
[phone]
METHOD BLANK: 1880294
Matrix:
Water
Associated Lab Samples: 92321515001. 92321515002
Blank
Reporting
Parameter
Units
Result
Limit
Analyzed Qualifiers
Total Petroleum Hydrocarbons
mglL
ND
5.0
12/02/16 07:58
LABORATORY CONTROL SAMPLE:
1 BB0295
Spike
LCS
LCS % Rec
Parameter
Units
Cone.
Result
% Rec Limits Qualifiers
Total Petroleum Hydrocarbons
mglL
20
16.7
84 64-132
MATRIX SPIKE SAMPLE: 1880296
92320870001 Spike MS MS % Rec
Parameter Units Result Cone. Result % Rec Limits Qualifiers
Total Petroleum Hydrocarbons mglL ND 20 16.2 81 64-132
Results presented on this page are In the units Indicated by the "Units" column except where an alternate un[t is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Dale: 12/07/2016 10:13 AM without the written consent of Pace Analytical Services, LLC. Page 7 of 14

CeAnalyiical
wmpacews.00m
f
Project: OILAND GREASEIMETALS
Pace Project No.: 92321515
QC Batch: 339076
QC Balch Method: EPA 200.7
Associated Lab Samples: 92321515001, 92321515002
METHOD BLANK: 1880242
Associated Lab Samples: 92321515001, 92321515002
Parameter
Units
Copper
ug/L
Lead
ug/L
Zinc
ug/L
QUALITY CONTROL DATA
Analysis Method: EPA 200.7
Analysis Description: 200.7 MET
Matrix: Water
Blank Reporting
Result Limit Analyzed
ND 5.0 12/03/16 20:38
ND 5.0 12/03/16 20:38
ND 10.0 12/03/16 20:38
Qualifiers
Pane Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
LABORATORY CONTROL SAMPLE:
1880243
Spike
LCS LCS % Rec
Parameter
Units
Cone.
Result % Rec Limits Qualifiers
Copper
ug/L
500
509 102 85-115
Lead
ug/L
500
494 99 85-115
Zinc
ug/L
500
506 101 85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 1880244
MS
92320967001 Spike
Parameter Units Result Conc.
Copper ug1L 108 500
Lead ug/L 108 500
Zinc ug/L 292 500
MATRIX SPIKE & MATRIX SPIKE DUPLICATE:
1880246
MS
92321515001
Spike
Parameter Units
Result
Conc.
Copper ug/L
ND
500
Lead ug/L
ND
500
Zinc ug[L
424
500
1880245
MSD
Spike
MS
MSD
MS
MSD
% Rec
Conc.
Result
Result
% Rec
% Rec
Limits
RPD
500
627
626
104
104
70-130
0
500
597
595
98
97
70-130
0
500
803
797
102
101
70-130
1
1880247
MSD
Spike
MS
MSD
MS
MSD
% Rec
Conc.
Result
Result
% Rec
% Rec
Limits
RFD
500
532
527
106
105
70-130
1
500
493
489
99
98
70-130
1
500
924
921
100
99
70-130
- 0
Resuhs presented on this page are In the units indicated by the "Units" cotumn except where an alternate unit is presented to the right or the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/07/2016 10:13 AM without the written consent of Pace Analytical Services, LLC.
Qual
Qual
Page 8 of 14

aceAna4ftal'
WWI I .esopm
QUALITY CONTROL DATA
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: OILAND GREASElMETALS
Pace Project No.: 92321515
QC Batch: 339137
Analysis Method:
SM 2540D
QC Batch Method: SM 2540D
Analysis Description:
2540D Total Suspended Solids
Associated Lab Samples: 92321515001, 92321515002
METHOD BLANK: 1880494
Matrix: Water
Associated Lab Samples: 92321515001, 92321515002
Blank Reporting
Parameter
Units
Result Limit
Analyzed Qualifiers
Total Suspended Solids
mg/L
ND
2.5 12/02/16 11.29
LABORATORY CONTROL SAMPLE:
1880495
Spike LCS
LCS % Rec
Parameter
Units
Conc. Result
% Rec Limits Qualifiers
Total Suspended Solids
mg1L
250 238
95 90-110
SAMPLE DUPLICATE: 1880496
92321429002 Dup
Parameter
Units
Result Result
RPD Qualifiers
Total Suspended Solids
mg/L
ND
ND
SAMPLE DUPLICATE: 1880497
92321483001 Dup
Parameter
Units
Result Result
RPD Qualifiers
Total Suspended Solids
mg/L
21.8 20.0 9 D6
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: 12/07/2016 10:13 AM without the written consent of Pace Analytical Services, LLC. Page 9 of 14

IneArWcal"
WWW.Parolabatorrr
f
QUALIFIERS
Project: OIL AND GREASE/METALS
Pace Project No.: 92321515
DEFINITIONS
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.
Pace Analytical Services, LLC
9800 KinceyAve. Suite too
Huntersvitle, NC 28078
[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, 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-Nilrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TN accredited. Contact your Pace PM for the current list of accredited analytes.
TNI - The NELAC Institute.
LABORATORIES
PASI-A Pace Analytical Services - Asheville
PASI-C Pace Analytical Services - Charlotte
ANALYTE QUALIFIERS
06 The precision between the sample and sample duplicate exceeded laboratory control limits.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/07/2016 1013 AM wtthout the written consent of Pace Analytical Services, LLC. Page 10 of 14

IceArWcale
Www.pac ubsccra
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project:
Pace Project No.:
OIL AND GREASE/METALS
92321515
Analytical
Lab ID
Sample ID
QC Batch Method
QC Batch Analytical Method
Batch
92321515001
OUTFALL I GRAB
EPA 1664B
339088
92321515002
OUTFALL 2 GRAB
EPA 1564B
339088
92321515001
OUTFALL 1 B GRAB
EPA 200.7
339076 EPA 200.7
339242
92321515002
OUTFALL 2 GRAB
EPA 200.7
339076 EPA 200.7
339242
92321515001
OUTFALL I GRAB
SM 2540D
339137
92321515002
OUTFALL 2 GRAB
SM 2540D
339137
Date: 12/07/2016 10:13 AM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 11 of 14

�__.� P�cPArtr?lyfr'Cr�1 j
- 1
Document Name:
Condition Upon Recei
Docuntent,No.:
F-CAR-CS-033-Rev.01
Document Revised: Sept. 21, 2016 t
Page 1 of 2 j
Issuing Authority:
Pace Quality Office
Laboratory receiving sa pies:
Asheville [V Eden[] Greenwood ❑ Huntersville ❑ Raleigh❑ Mechanicsville❑
• Client name: {{ W0# : 92321515
�9 (r Project #:
Courier: Fed Ex ❑UPS ❑USPS ❑Client�'I'
❑ Commercial ❑Pace ❑Other: 92321515
Custody Seal Present? ❑Yes (Jo Seals Intact? ❑Yes ❑No
Date/Initials Person Examining Contents:
Packing Material: [iBubble Wrap Bubble Bags ❑None ❑Otheri
Thermometer
Type of Ice: Vel ❑aloe ❑t:nne ❑52mpies an ice, cooking process has begun
Correction Factor: Cooler Temp Corrected (•C): �, �j' Biological Tissue Frozen? ❑Yes ❑No El N/A
Temp should be above fre ing to 61C
USDA Regulated Soil ( M N/A, water sarnple)
Did samples nginate in a quarantine tone :vAlhin the United 5tates: CA, PJY, or SC (check maps)? Did samples origmate from a foreign source(inlet ranally,
nYes Pin includine Houton and Pumtn RiroP nYes ,Io
—�—
Comm ents/Discr_epancy., )
E Cf,ain of Custody Present?
Yes ❑Ne
❑_N/A
I.
2.
SamplesArri•led vrithin hold Time? es ❑,to ❑.:/A
Short Hold Time Analysis (<72 hr.)?
❑Yes
❑N/A
3.
Rush Turn Around Time Requested?
❑Ye No
❑N/A
4.
Sufficient Volume?
Ks ❑rNO
[]N/A
5.
G.
_
Correct Containers Used?s ❑ido ❑tl/A
-Pace Containers Used? Yes Cl No ❑,I/A
Containers Intact?
ES ❑NO
❑N/A
7.
Samples Field filtered?
❑Y s No
❑N/A
S. Note if sediment is visible in the dissolved container
Sam pie Labels Watch COO
-Includes Date/finiQ/iD/Analysis iylatrix:
yes ❑tie
Wr
'❑Yes
❑N/A
9.
Headspace in VOA Vials (>5-6mm)?
Trip Blank Present?
Trip Blank Custody Seals Present?
❑,!a
Dyes ❑n
❑Yes ❑NO
H A
A
NIA
10.
11.
_ Y
CLIENT NOTIFICATION/RESOLUTION
Person Contacted-
Comments/Sample
Discrepancy:
Date/Time:
field Data Required? ❑Yes []No
Project Manager SCURF Review: Date: l �p _
Project Manager SRF Review: _ Date: I L
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form vriii be sent la the North Carolina DEHHR Certification Office (i.e.
Out of hold, incorrect preservative, out of temp, incorrect containers)
Page 12 of 14

w
ro
w
0
A
i
m
3
m
I
0
v
ro
N
ro
C
ro
I
v
S
C
9
C
N
1
y
A
v
nay.
�
O
a 13
c
O
�
m
-O
a
�
N
•4
m e°
R �
0.
N
M N
tiY
o• �
`C3
D
tp
-3
0
rY T
n
m 4
CL
Y
m
I
�
Item#
7
BP4U-125 mL Plastit Unpreserved (N/A) (Cl-)
0P3U 250 mL Plastic Unpreserved (N/A)
1�
13122U.S00 mt Plastic Unpreserved (N/A)
BP1U-1 liter Plastic Unpreserved (NIA)
BP35-250 ml Plastic IM04 (PH 4 2) [Cl-)
BP3N-250 MLpla%tic HNO3 (pH a 2) --
XVCM-250
rnL Plastic ZN Acetate & NaQH (.9)
MC-250 ml Piastic NaOH (pH s 12) (CI-)
�li
I I
WGFU-wide-mouthed Oassjar Unpreserved
AG1U-1 IitcrAmber Unpreserved (NIA) (Cl-)
AG1H-I IiterAmber HCI (pH < 2)
AG31.1-250 mL Amber Unpreserved (NIA) (CI-)
/
I AG3S-1 liter Ambrr H2504 (pH c 2)
0
AG3S-250 mLAmbr:r H2SO4 (pH <2)
AGM(DG3A)•250 MAmber tM40 (N/A)(CI-)
+
I
DG9H-40 mLVOA HCl (N/A)
!
IH
VG9T-40 mL-40 mL VOA Na2S203 (N/A)
VG9U-4Q mL VOA Ul p(MIA)
DG9P-40 mL VOA H3PO4 (N/A)
I
I
4
i
j VQA1C (6 vials per kit)-5035 kit jN/A)
I V/GK (3 vials per kit)-VPH/Gas k4 (N/A)
I
SPST-125 mL Sterile Plastic (NIA —!ab)
l
5P2T-7.50 mt. Stttriie Plastic (NIA —lab)
BP3A-250 mL Plastic (NH2)2504 (9.3-9.7}
Cubitainer
VSGU-20 mL Scintillation vials (N/A)
GN
EIJ.�
- -9 N• ,,•
m w Z
0 n
3
=r su m
O
Cr
a a
x
� � T
a m
IN Cr
3
Cr n 67
� � 7
ni
o� s o
Cr c.
pn
� � S
O
0
n z C
o - on
o �
63 � 21
r
w 0
S Z I
m o z a
m
a ^
0
1 =
n
3
to

Nr
0
CHAIN -OF -CUSTODY / Analytical Request Document cc
R7r.Cilr:lfl'1I a
... The Chain•of-CustvUy is a LEGAL DOCUMENT. All relevant fells must be completed accurately.
Se ti*n A Section a Secfion C -
Regwred Client Inlonnation: Required Project Intdrmaitgn: Invoice Inlornwtlow
ComPonY. A tli! Fuel 5 Brame Resort To llaro ,f d N / �F f1 t( AE}enlian:
Address. 1010 Qorporalo Center Drive Cony To / CI�/,I &a., l i-S . Company NAme:
Saiiaou . NC $91Cfi
CUrYj
Address'�
Eennn� �Cr/� �G �LlTY - reef
Aurchnse Order N
Pace ouole
Phone 704 y 7v ,� Fe:.o
Piylccl Nnme. Oil and Grea%&M^fois
Px* Propat Manager angela baDne&V=Wabzcdm.
' ' " State r Location ". F
Reeves" Due Drain,
Prdlen a
Pace PrMile N 81RI-1
Ite
itwol
Anal
i Rlterad
rN
'
l�
Z
h{A I4P GOIX
u
COLLECTED
z
Preservatives
}
iJimii.i Wu'er rm
W.
U
wr
was. w.Mraw
Preeuri
SAMPLE ID eL
�
�
u
START
END
u
�
u
w
p
♦`_
Z
one Character per Wx. 'N" wn
s
g
{Ay 0.9 !. •I an„ n
Sample Ids CC
,'o.
S
it
must unique r,z
J
Ul
~
/o
LAT
TIME
ES7o
DA
TM[
a
C3 iJ i r A G C 147 4?
—
G
r z�
'�:-fc
F
3
✓✓✓
Q
3
4
5
7
8
9
10
17
12
!
. ADDITIONALCOMWNTS
AWNGULSHM BY l AFFIUA flow
DATE
•...TIYIE'
-• ACCEPTED eYlAFF&IA710N �: ,,
DATE`
;TIME
1 - :&SMPLE GOstOfTrtJN3 -
I//Jo /
/; 0L)
RG�rr'rY
�C
SAMPLER NAME AND SIGNATURE -
PRINT Name of SAMPLER:
SIGNATURE or SAMPt,ER; ; f DATE Signal: / 251 /2Oi�
4
o
N
+ g �
e
r J r
y