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HomeMy WebLinkAboutNCG060317_MONITORING INFO_20190222STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V U&C 60a rI DOC TYPE ❑ HISTORICAL FILE i� MONITORING REPORTS DOC DATE �- ❑ YYYYMM DD .. • SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT ` for North Carolina Division of Water Quality General Permit No. NCG060000 f r %' , p 0 3! Date submitted % Z Z 2-&S— RECEIVED CERTIFICATE OF COVERAGE NO. NCG06 0 0 D SAMPLE COLLECTION YEAR '-:20 JUN 2 5 2015 FACILITY NAME 8�45� .ST�?� /j%iL-�Ia6 FACILITY ACTIVITIES INCLUDE (check all that apply): CENTRAL E COUNTY C_r_ . ❑ use/process meats ❑ use animal fats/ byprodutMWR SECTION PERSON COLLECTING SAMPLES LL DISCHARGING TO SALTWATERS? [:]YES XNO LABORATORY-';a1220s L Lab Cert. # V io /v c DPJ "3 Y795SS` PLEASE REMEMBER TO SIGN ON THE REVERSE �! IfP/9 '041c 0090� Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall Z, /Q or n No discharge this period' � .�:... -. ?. tv Outfall No R„,� „- - g•� �,- _ , j -"a�.l_�.: `e;i,_' .Y ... o .,_� Sample Collected„ 9 :r ` .+`,''-. II' mo%d"d/Yr, _ �, TSS, L'rry ,jmg/L'^,,, � .. ; pHi, fi e ` �_5tandar`dunits „:. _ _ - .,. COD, ; < �mg/L� - - .IL F O.il and,Grease, ai.� y mg/,L.', ,,�.? "'+g' fi 'T i; ��..... ' - `Fetal Coliform�;, y �',• ��. ,�Colonlesip -"be^�f.;��z'e�1=^ ? r Enterococcis ; olonies per 100�m1e B n #mark " � �_ ; _,Y r 100'ar_50 --wit in�6 0 - 9 0 120 .. 30x*, w..K rr ,� r 000�cM� 2 7wi. .ii 500 FSh. a oy6,604 20 Q S7D 1 Only applies to facilities that use/process meats. 2The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at AU outfalls. You must still submit this discharge monitoring report with a checkmark here. 4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes [q no Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month. Ouffall No . ;� Sample Collected, mo/dd/yr .;_._?„mg/._L, Oil arid'Grease, ` �755;`;' � mg/L� - pH F,Standad.units,�. New 0 to or 011 Usage, c, Annual averageagal/ma,;t Benchmarks - 100.Orr 50 1 Only applies to facilities that use/process meats. 2The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here. 45ee General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies (f yes, complete Part B) S WU-249 Last Revised: October 18, 2012 prop I of 7 *,FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALLTRIGGER 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 ❑ NOK IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an on inal and one copy of this DMR including all "No Discharge" re orts within 30 days of recef t o the lab results Lor at end o monitoring period in the case of "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh,, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signa0 f e of Permittee 6/aa/%— (Date) Additional copies of this form may be downloaded at: httl2://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4 SWU-249 Last Revised: October 18, 2012 haae.') of l SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT IV1 IVUI LlI %.01IUII1143 LJIVIWUII VI VVCILCI %ALJCIIL VCIICICII rC11III L 1W. I114L7V0DUVV Date submitted %I .23Is — -'` CERTIFICATE OF COVERAGE NO. NCGO6 01 L 2 FACILITY NAME COUNTY — "' LL PERSON COLLECTING SAMPLES D K CA in 118 4F L� LABORATORYS71aT11 U!w£ Lab Cert. # d ANp,-* 1 CAc_ A/cp4) vc 37 Part A: Stormwater Benchmarks and Monitoring Results Outfan'Nn. .9arr pIbt6Ilkt6d, rtio%dd/yr. 'SS, ng/L pH, Standard units COD, mg/L oil'an&drease, - trig/L fecal Collfor,` • m Colonies jeer 140 ml i �nteincocd ," Cnloniis per: iDO;ml.' Benchmark l00 or 50 ; ; '. Within fi0 - 9.0 120 30.. 1000 500 b 7 Y 5 .S 2 3S' AS.z Only applies to facilities that use/process meats. 2The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at Any outfalls. You must still submit this discharge monitoring report with a checkmark here. °See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes &no Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month. OutfaII No „u •,` Sample Collected, : mo/,dd/.yr.', ,011[and Grease, E mg FSS,' mg/,L° pH; ° A �: Standar`d'units New Motor Oil Usa$eg Annua6aVerage,gal/mo ; eenchma�k`� =r30 M`100 or 50 rb O �:g 0 Fx., Ir 1 Only applies to facilities that use/process meats. 2The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here. `See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. SAMPLE COLLECTION YEAR 60 / S FACILITY ACTIVITIES INCLUDE (check all that apply): U - �daness meats Ouse animal fats/byproducts V " 5ALTWATERS? ❑YES SNO DEC 01 2015 PLEAS9 REMEMBER TO SIGN ON THE REVERSE 4',•>• CENTRAL FiLE5';_ DWR SEC olfa�event rainfall 2 it or ❑ No discharge this period' 'X (if Yes, complete Part B) SWU-249 Last Revised: October 18, 2012 Page I of 2 *FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • -1 EA- EDANCES 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 [JNOK IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO X] REGIONAL OFFICE CONTACT NAME: Mail an on final and one copy of this DMR includingall "No Dischar e" reports, within 30 days a revel t o the !a6 results ar at end o monitoring period in the case of "No Discharge" reports to; Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, NC 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." of (Date) Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4 S WU-249 Last Revised: October 18, 2012 Page 2 of 2 Bay State Milling Co. Post Office Box 358 Mooresville, NC 28115 Receive Date: Reported: For: Comments: Analytical Results 10/28/2015 11 /06/2015 Stormwater Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 151028-14-01 Chemical Oxygen 1 35 mglL HACH8000 10129/2015 CL Demand 151028-14-01 Oil and Grease 1 <52 mg1L EPA1664RevB 11/0412015 MD 151028-14-01 TSS 1 15.333 mglL SM254OD-1997 10/30/2015 WL 151028-14-02 Chemical Oxygen 2 30 mglL HACH8000 10/29/2015 CL Demand 151028-14-02 Oil and Grease 2 <5.3 mg/L EPA1664RevB 11/04/2015 MD 151028-14-02 TSS 2 6.375 mglL SM254OD-1997 10/30/2015 WL Respectfully submitted, LP-WOL, �[ Dena Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 a Statesville, NC 28687 a 704/872/4697 Page 1 of 2 Client: 4 y e STATESVILLE ANALYTICAL 122 Court Street • . P.Q. Box 228 Statesville, NC 28687 (7G4) 872-4697. .r. Chain of Custody Record. Address: o a + S Contact Person: -l'i 'R01f Phone # cl ! _ 73 FAX# ?/�1 01- - , & PO # Requisitioned by: T Mme D t� Customer Sample ID# Sam p Lab -ID # - Time Sampled (Grab Only) Date Sampled (Grab Only) Matrix parameters requested for analysis sn,ape w I ww s rs Dv G ff Relinquished by: p � � � A. � Received by: J Relinquished by: Received by: . Composite sa lnq ft. Time begin_ pm Dated Time end ar"ir , pm Date �t1J1..� CQmnosite Sampling #2: Time begin ;LD ,-pm Date 1Ej2z1j_Z_ Time end % m Date�f�!` Time 35 m, pm Date �� �• Time / ✓ am pm Date/_��J7Sl Time am, pm Date _ J�/ Time am, pm Date ��_ Lab comments: D ,/ Sam pled by: Transported by: Holding times met: Compliance work: Non-compliance work: I SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT for North Carolina Division of Water Resources General Permit No. NCG060000 Date Rt kmmrZdFjli Z// 9 - CERTIFICATE OF COVERAGE NO. NCG060 3 1 7 MAR 2 8SAI&JQLE COLLECTION YEAR 1;20 1 1 FACILITY NAME Bay State Milling Company FACILITY ACTIVITIES INCLUDE (check all that apply): COUNTY Iredell C N, RJkL FILE use/process meats [] use animal fats/byproducts PERSON COLLECTING SAMPLES kj-J �/� L �--':;;IG 4RGENG TO SALTWATERS? OYES XNO LABORATORY - fVi(_L1Z A.A a Cert. # NG A( 5/�O /"Ad 4' 3 7 % 35' PLEASE REMEMBER TO SIGN ON THE REVERSE Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall' / 1(or ❑ No discharge this period' Outfall No° ;Sample Collected, • -Nmo/dd/yr- TSS,: mg/L,e . pH, , 5tanda4units. CQD, mg/L , Oil and Grease, mg/L Fecal Collform , Cdlonies per l00 m1' Enterdcocci , - Colonies per 100 m1. r` Benchmark r'.. - 100 or,50. Within :Q-9.0;. 120 30 lOQO S r 1 Only applies to facilities that use/process meats. 2The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here. 4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Oyes 9 no Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month. _,,:Outfalll Na t;.-- Sample" 6111ected, mo%dd/yr .•r, - Ciii and`.Grease,' mg/Lf , TS5; _ mg/L: pH,�r :— __:, __ Standard units NewAdtor 0nI Usage, 'An ual average gal/rrio '.Benchmark , - . ' 30 100 or 50 Only applies to facilities that use/process meats. 2The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at Any outfalls, you must still submit this discharge monitoring report with a checkmark here. 4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. if yes, complete Part B) SWU-249 Last Reviged: October 18, 2012 Page I of 2 *FOR PART A AND PART B MONITORING RESULTS: y • 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: r Mail an original and one copy 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 Resources Attn: DWR Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee) (Date Additional copies of this form may be downloaded at: http:/Zportal.ncdenr.org/web/wq/ws/su/npdessw#tab-4 SWU-249 Last Revised: October 18, 2012 Page 2 of 2 Analytical Results Bay State Milling Co. Post Office Box 358 Mooresville, NC 28115 Receive Date: 02/18/2019 Reported: 03/22/2019 For: Comments: Sample Number parameter Sample ID Result Unit Method Analyzed Analyst 190218-13-01 Chemical Oxygen #1 <25 mg1L HACH8000 02/21/2019 CL Demand 190218-13-01 Oil and Grease #1 9.1 mg1L EPA1664Rev8 02/20/2019 CL 190218-13-01 TSS #1 22 mg/L SM2544a2011 02/22/2019 WC 190218-13-02 Chemical Oxygen #2 <25 mg/L HACH8= 02/21/2019 CL Demand 190218-13-02 Oil and Grease #2 6 mg/L EPA1664RevB 02/20/2019 CL 190218-13-02 TSS #2 10.5 mg/L SM2WD-2011 02/22/2019 WC Respectfully submitted, Dena Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 3 O 0 x N N 00 rt m rt rn c m Z ri 1V 00 F 00 V Client: r L ALA STATFSYlLLE ANALY7lCAG 122 Coen Sueet • P.O. Box 229 Stateaville,NC 29681 quil) 872-4697 Chain of Custody Record Address: Od Mot, Conttxt Per$": _ .�- Phone N e _ FAX# Po 0 Requisitioned br. Customer In�ID s Time SaMPIRd IRrab Date Sampled (Grab atr fmo. w war Pararnstare raques<ad for anelyah. CIO 7' # t3.o2C 0 Relinquished by: Received by: Relinquished by: Received by: -- - - Composite SamSam Iing�g pt: 'rime begin1c11¢6 pm Date a--JAJ-d Time end 7% pm Date -1 /&,% Time begin r pm Date �I[(,J/g Time and�m Date 2-I JK4 Time �3O am, pm Date z �II � Sampled by: Time ii30 am, pm Date —2, t l�' Transported by: Time am, pm Date _ 0./Holding times met t Time am, pm Date Compliance work: Non-compliance work: Lab Commonta: � � b y Ik-07,P (7 �� ` ' \ SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT for North Carolina Division *f Water Resources General Permit No.NCGD6O0W0 Date submitted 1/2 //1 CENED CERTIFICATE 0fCOVERAGE NO. M[GO60 3 1 7 B 8���U|� Company-------- FACILITY NAME COUNTY Iredell PERSON COLLECTING SAMPLES Part A: Stmrnn*vmterBenchmarks and Monitoring Results FACILITY ACTIVITIES INCLUDE (check all that T I& use/process meats El use animal &� KiA, MN DISCHARGING TO SALTWATERS? OYES FVNO PLEASE REMEMBER TOSIGN OWTHE REVERSE 4 � itTot�e�n�k�V orF1Nodischarge this period 3 P. ` Only applies tofacilities that use/process meats. zThe total precipitation must horecorded using data from anon-site rain gauge. ^ For sampling periods with nodischarge at2U outfalls. You must still submit this discharge monitoring report with a checkmark here. ^ See General Permit text, Table 3'idendfying the especially sensitive receiving water classifications where the more protectiv6 benchmark applies. Did this facility performVehicle Maintenance Activities using more than 55gallons of new matoroil per month? Elyes Q0~~ Pm,tB: Vehicle Maintenance Area Monitoring Results: only for facilities averaging *SGgal ufnew motor mU/nnunth. d' 'Oi and Grease, g mg rk ` Only applies mfacilities that use/process meats. 2The total precipitation must be recorded using data from an on -site rain gauge. ^Forsamp|in8pedodow|thnodischarQeatalyoutfoUs,youmusts,|Usubmitthisd|ucharQemunitndngrepurt with ocheckmarkhere. +See General Permit text' Table 3' identifying ,he especially sensitive receiving water classifications where the more protective benchmark applies. (jjgjcomplete Part 8) 8VyD-240 Last Revised: October i8,Z0l2 Page |of2 *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 SECTIONS. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO �g— IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an on inal and one copy of this DMR including all "No Discharge" re arts within 30 days of receipt of the lab results tor at end of monitorina geriod in the case o "No Discharge" re arts to: Division of Water Resources Attn: DWR Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, iny��o§sibility of fines and imprisonment for knowing violations." (Sigrgature of Permittee) Z-7 (Date) Additional copies of this form may be downloaded at: http://portal.ncdenr.orglweb/wq/ws/su/npdessw#tab-4 S WU-249 Last Revised; October 18, 2012 Page 2 of 2 Analytical Results Bay State Milling Co. Post Office Box 358 Mooresville, NC 28115 Receive Date: 12/14/2018 Reported: 01/03/2019 For: Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 181214-09-01 Chemical Oxygen OF1 <25 mg/L HACH800o 12/17/2018 CL Demand 181214-09-01 Oil and Grease OF1 7.49 mg/L EPA1664RevB 12/28/2018 CL 181214-09-01 TSS OF1 7.485 mg/L sM2540o-2011 12114/2018 WC 181214-09-02 Chemical Oxygen OF2 <25 mg/L HACH8000 12/17/2018 CL Demand 181214-09-02 Oil and Grease OF2 6.29 mg/L EPA1664RevB 12/28/2018 CL 181214-09-02 TSS OF2 6.75 mg/L SM254OD-2011 12/14/2018 WC Respectfully submitted, a'-W0G0-r-htI Dena Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 3 Condition of Receipt Sample Number 181214-09-01 Temp on Arrival: 2.3 PH on Arrival: <2 Parameter Schedule: Oil and Grease Hydrochloric Acid Received on Ice Chemicals in containers, lab Parameter Schedule: TSS Received on Ice PH on Arrival: <2 Parameter Schedule: Chemical Oxygen Demand Sulfuric Acid Received on Ice Chemicals in containers, lab Sample Number 181214-09-02 Temp on Arrival: 2.3 PH on Arrival: <2 Parameter Schedule: Oil and Grease Hydrochloric Acid Received on Ice Chemicals in containers, lab Parameter Schedule: TSS Received on Ice PH on Arrival: <2 Parameter Schedule: Chemical Oxygen Demand Sulfuric Acid Received on Ice Chemicals in containers, lab PO Box 228 a Statesville, NC 28687 • 704/872/4697 Page 2 of 3 O O x N N 00 a m m z n N 00 rn 00 V � o � A m 0 w � N w A V Clferlt: /'tom , STAMVUJZ ANALWMCAL 122 Caul Snd - P.O. Bait 228 suftnil NC 28U7 (704)872d697 Chain of Custody Record Addle": A ,J' r^- i3 Cnted Persl 0n: Phone FAX# aelA, PO N RequIsitknedby � S Dees) Cuskmr Laer101 - Time jGreb Orel!'} Mesh Perotueerr w y,N, j Pr% 8 COO y r 4 ? ct Relinquished by: vby by:' Received by onlnncalte Sampling #I: Tme tiegln ! pm Date gIj-Yjjl Time end ', 6h. pm • Data W-j±—S t:ompashe SamMfna 12:_ Time begin.'' Zv & pm Dste"J-1 Time end % pm Date 1_1&/ Time ULU am, Date � / sampled by: Time I `Um, e�tReeied Transported by:. 1�Relinquished Time am. pm Date--J—J—.. , liolding,tirnes met:. ' nme am, pm DJ�J•-_J_ Compliar6 work: ✓ `' Non compliance work, Lab ft: 8ernplee Trerlsportetl ore lee: , 0/ PN (o ■ a �" G a : Condition of Receipt Temp on Sample Number 141117-16-01 Arrival: 2 PH on Arrival: <2 Parameter Schedule: Oil and Grease Hydrochloric Acid Received on Ice Chemicals in containers, lab Parameter Schedule: TSS Received on Ice PH on Arrival: <2 Parameter Schedule: Chemical Oxygen Demand Sulfuric Acid Received on Ice Chemicals in containers, lab Temp on Sample Number 141117-16-02 Arrival: 2 PH on Arrival: <2 Parameter Schedule: Oil and Grease Hydrochloric Acid Received on Ice Chemicals in containers, lab Parameter Schedule: TSS Received on Ice PH on Arrival: <2 Parameter Schedule: Chemical Oxygen Demand Sulfuric Acid Received on Ice Chemicals in containers, lab PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 2 of 2 Analytical Results Bay State Milling Co. Post Office Box 358 Mooresville, NC 28115 Receive Date: 11/17/2014 Reported: 12/0212014 For: Stormwater Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 141117-16-01 Chemical Oxygen OF1 46 mg/L HACH8000 11/18/2014 CL Demand 141117-16-01 Oil and Grease OR <6.0 mg/L EPA1664RevB 11/25/2014 MD 141117-16-01 TSS OF1 33.67 mg/L SM254OD-1997 11/19/2014 HM 141117-16-02 Chemical Oxygen OF2 38 mg/L HACH8000 11/18/2014 CL Demand 141117-16-02 Oil and Grease OF2 <6.4 mg/L EPA1664RevB 11/25/2014 MD 141117-16-02 TSS OF2 56.8 mg/L SM254OD-1997 11/19/2014 HM Respectfully submitted, Dena Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 2 *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 ANYONE OUTFALL? YES ❑ NO Z IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an on inal and one copV of this DMR includin all "No Discharge" re orts within 30 da s of receipt of the lab results or at end o monitoring period in the case o "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signaturg f Permittee) j2 /Z/ /-Z (Date) Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4 S WU-249 Last Revised: October 18, 2012 Page 2 of 2 SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT for North Carolina Division of Water Quality Gpneral Permit No..NCG060000 Date submitted 12- // Z/ RECEIVED CERTIFICATE OF COVERAGE NO. NCGO6 SAMPLE COLLECTION YEAR a 0 / 4- _P1 / 2 DEC 0 9 1914 FACILITY NAME: RAY SM747� ' ^1-42l116 FACILITY ACTIVITIES INCLUDE (check all that apply): COUNTY_Zf Duse/process meats Duse animal fats/byprodu&ENTFZAL FILES PERSON COLLECTING SAMPLES __=o GLr DISCHARGING TO SALTWATERS? DYES �NO DWR SECTION LABORATORYLab Cert. # VC C047--t,9 IVC, 671% #/L/C 0 Cyocf 'S<S.— PLEASE REMEMBER TO SIGN ON THE REVERSE 4 Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall 2 14 or D No discharge this period3 t AMA tt 1 nd '1.A' , �,'f zt&'Cil cwifof 0 4Imar •1 1, 0,' �' Within ' "A 7brn ! 8 /Z 7 1-3 &7 IS-LI .4 Z> 0711 CZ2 6, 23 IF I Only applies to facilities that use/process meats. 2 The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at M outfalls. You must still submit this discharge monitoring report with a checkmark here. 4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Dyes [21no Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month. N j o;�e ,�Woutfalli'N 2 Z'SaMp 'qWTSS, PW g lk"r 'iiw.jMotorj0l Usage, %-g, P'074�ARA 1%4''Nl­ !Benchmark. u I Only applies to facilities that use/process meats. 2 The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at 2ny outfalls, you must still submit this discharge monitoring report with a checkmark here. 4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. (if yeS complete Part B) SWU-249 Last Revised: October 18, 2012 Page I of 2 SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT for North Carolina Division of Water Q ality General Permit No. NCG060000 RECEIVED fAj` �t G ��' Date submitted '7 a3 l JUL g .,1j¢ CERTIFICATE OF COV RAGE NO. 06 ® O SAMPLE COLLECTION YEAR CENTRAL FILES FACILITY NAME S LL FACILITY ACTIVITIES INCLUDE (check all that apply): OWO/BOG COUNTY use/process meats ❑ use animal fats/byproducts PERSON COLLECTING SAMPLES _ tlA- '6 7c'f Ai DISCHARGING TO SALTWATERS? [-]YES KNO LABORATORY S (/? �s S 1/ u!;—i4MLab Cert. # VY67 ANA 4,y tc,*4- N c-0 w 6e4rx A 377ss Part A: Stormwater Benchmarks and Monitoring Results PLEASE REMEMBER TO SIGN ON THE REVERSE 4 Or Total event rainfall z_ or ❑ No discharge this period' �Outfall No » Sample CallettedT55,€ ;mo/dd/.yr Al mg�L rpH,Pas . ;;a5tandard!units! COD, ::.1 rrig/Lr x-011iandiGrease, tmg/L h, , , -, Fecal Collform , �.�� ^' :Colanles; per.,100,m1 Enterococcf ,; ,U Colonies per._f00;m1$ Benctimarkn,�.,. s 100'for 50 :' . ,Illlithn b 0`9 0 :' 124_ 6 1Ajf &V Z/,-57- -C D b A 2 11616RlIqZ i 4 ' 1 Only applies to facilities that use/process meats. ZThe total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here. 'See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes VLno Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month. OutfallNo w Sample Collected, :-;-Inia/dd/,yr , Oil end Grease, <� dmg/L :. :' TSS, ?: m ;L, pH; - Standar.d..units. New Motor oi! Usage; Annual average Beiichmarlc„ = - "� 3 30 y `. 100 nr: 50 , 60 - 9 0..' (if yes, complete Part B) 1 Only applies to facilities that use/process meats. ZThe total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here. 4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. S W 11-249 Last Revised: October 18, 2012 plop 1 of 7 IN *FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO REGIONAL OFFICE CONTACT NAME: Mail an original and one cojoltof this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end o monitoring period in the case of "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Date) Additional copies of this form may be downloaded at: http://f)ortal.ncdenr.org/web/wq/wsl.su/npdessw#tab-4 SWU-249 Last Revised: October 18, 2012 N(ye.. ? of 7 r 7/23/2014 Dear Sir, I pulled a second sample on SDO # 2. It ran over on TSS BY 12. We had put in steps near a drain and this was the cause for it to go over 100. The second sample ran very good. Tried to pull within 30 days of first sample but we didn't have the rain. Samples would have been sent on sooner but delay was waiting on lab. Thanks John Campbell Packing/Shipping Supt. 9, � Analytical Results Bay State Milling Co. Post Office Box 358 Mooresville NC 28115 Entered 6/9/2014 Reported: 6/17/2014 For: Stormwater Date Sample ID Parameter Cust ID Result Units Method Analyzed Analyst 140609-2.1 COD SDO1 <20 mg/L HACH8000 6112/14 MD 140609-2.1 Oil & Grease SDOi 10.7 mg/L EPA1664RevA 6/12/14 MD 140609-2.1 pH SDO1 6.78 STD units SM4500HB-2000 6/9/14 MD 140609-2.1 TSS SDO1 14.5 mg/L SM2540D-1997 6/12/14 HM 140609-2.2 COD SD02 <20 mg/L HACH8000 6/12/14 MD 140609-2.2 Oil & Grease SD02 6.6 mg/L EPA1664RevA 6/12/14 MD 140609-2.2 pH SD02 6.87 STD units SM4500HB-2000 6/9114 MD 140609-2.2 TSS SD02 112 mg/L SM254OD-1997 6/12/14 HM Respectfully submitted, �6 V\"/\ Ljp%--� Dena Myers NC Cert #440, NCDW Cert #37755, EPA NC00909 P.O. Box 228 • Statesville, North Carolina 28687. 704/872/4697 Analytical Results Bay State Milling Co. Post Office Box 358 Mooresville NC 28115 Entered 7/11/2014 Reported: 7/23/2014 For: Storm water Sample ID Parameter Cust ID Result Units Method Date Analyzed Analyst 140711-10 NH3N OF#2 <0,5 mg/L SM4500NH3E 7121/14 WL 140711-10 Oil & Grease OF#2 <5.9 mg/L EPA1664RevA7/22/14 MD 140711-10 T5s OF#2 33.7 mg/L SM2540D- 7/11/14 JM Respectfully submitted, Dena Myers NC Cert #440, NCDW Cert #37755, EPA NCO0909 P.O. Box 228 * Statesville, North Carolina 28687 * 704/872/4697 for North Carolina Division of Water Qualityrmit No. Date submitted 41C CERTIFICATE OF COVERAGE NO. NCG06_() SAMPLE COLLECTION YEAR Z6 FACILITY ACTIVITIES INCLUDE'(check all that apply): COUNTY r— use/process meats [] use animal fats/byproducts; UL PLEASE REMEMBER TO SIGN ON THE REVERSE 4 CENTRAL FILES x 1 ~ Part A: Stormwater Benchmarks and Monitoring Results DWR SECTION Total event ro - - or 0 No discharge this period3 mo en ix �Onlyapplies unfacilities that use/process meats. � ;The total precipitation must be recorded using data from anon-site rain gauge. aForsampdingpododovithnudischurgeatany�outfa|b.Youmuststi||subm|tthisdischargemonitndnQoeportwithacheckmarkhene. `See General Permit text, Table 3' identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?E:] yes kno Part 13: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month. Nt ey ark ` Only applies to facilities that use/pmmomeats. zThe total precipitation must berecorded using data from anon-site rain gauge. a For sampling periods with no discharge at gny outfalls, you must still submit this discharge monitoring report with a checkmark here. -SeeGenem|Pe'mittext,Tob|e3,idendfyingtheespedaUysnnsit\verece|vim8m/pte,dxoificadonswhcre1hemorep'otectivebenchmarkopp|ioo. (Lf yes, complete Part B) SWO-249 Last Revised: October \8,20l2 *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. a TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of 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, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (SignatOO df Perm Ia /6 (Date) Additional copies of this form may be downloaded at: http:lll2ortal.ncdenr.orglweb/wq/ws/sulnpdessw#tab-4 S WU-249 Last Revised: October 18, 2012 Page 2 of SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT for North Carolina Division of Water Quality General Permit No. NCG060000 Date submitted (. &E Izt. r 'CERTIFICATE OF. COVERAGE NO. NCG060 3 L2 FACILITY NAME !S &6 Sfj±a /6 COUNTY (t' C.L PERSON COLLECTING SAMPLES TaIti #J C4711 /Mg LC — LABORATORY ST.eT�s�Z45-, 4A)ACY74 Lab Cert. # !!�(/d NC jo tv d 3 7 Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 201 (d _ FACILITY ACTIVITIES INCLUDE (check all that apply): ❑ use/process meats ❑ use animal fats/byproducts DISCHARGING TO SALTWATERS? []YES ZNO PLEASE REMEMBER TO SIGN ON THE REVERSE 4 Total event rainfall z2,( or ❑ No discharge this period3 Outfall ho. Sample'Collid6d, mo%dd%yi.; TSS, . mg/L. pH, Standard units COD, mg/L • Oil and, -Grease;' mg/L Fecal Coliform , •-' Colonies. per 160m1_ Enterococd ,'` Colonies per 100.MI. '.. -Benchmark 100 orSO. s`WithIM&O - 9.0 126 30 1000 500 .< s� � jUN FILES Only applies to facilities that use/process meats. DWR SECTION 2The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here. 45ee General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes Kno Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month. Outfall No Sample°Collected,: . , 011;an Grease; 'pH, Silh ar`dunits •• New Motor OII.L!Sage, -Ann ualiaverage;gal/,mo':. 300'- " 10044 Only applies to facilities that use/process meats. 2The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at aU outfalls, you must still submit this discharge monitoring report with a checkmark here. 45ee General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. complete Part B) SWU-249 Last Revised: October 18, 2012 Page 1 of 2 *FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B. • ..TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO R IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ LN REGIONAL OFFICE CONTACT NAME: Mail an original and one copy of this DMUncluding all "No Discharge" re_ports_, within 30 daVs of receipt of the lab results for at end of monitoring period in the case o "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Sign of Permit ) (Date) Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wgZws/­su/`npdessw#tab-4 SWU-249 Last Revised: October 18, 2012 Page 2 of 2 qqI STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT GENDPAL PER ITT NO, NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR; �: CERTWCATE OF COVERAGE NO, NCG06 0-$1Z) i�;�wCring report is due at the Division Ao later than 30 dAye from �liaift'a facility receives the a m lye resul from the laboratory,) FAc>ZTrY NAmE r1J�o / w FEB 1 8 2019 COUNW 7/ ' _ z PERSON COLLECTING SAMPLES PHONE NO, ,d CERTIFIED LABORATORY 111,2a�kTil" Lab # -'i KHl_ FILES Lab 4 �Ff'�R SECTION PLEASE SIGN ON THE REVERSE Part A, Spealflo Monitoring Requirements Outfall Date 00530 00400 6-6340 00556 31616 No, Sample Total Susponded PE, Chomical'Orygon Oil and Grease, Focal Collform, Collected, solids, Standard units Demand, mg/L Colonies per 100 ml mo dd/ m m Bencbmark 100 Wit in 6,0 9 0 120 30 1000 Ve M Note; If you report a sampled value In excess of the benchmark value, or outside the benchmark range for pH, you must Implemont Tier I or TIer2 responses. Soo 0onoral Permit text, Did this thollity perform Vehlolo Maintenance Activities using more than 55 gallons of now motor all per month? _ yea _no (if yes, complete Part 8) Part. Bt Vehicle Maintenance Activity Monitorin¢ Requirements Outran No, I Date Sample Collected, mo/dd/ r 00556 00530 00400 On and Grouse, m ra Total Suspended Solids, m gH) Standard units New Motor Oil Usage, Annual average al/mo Benchmark .. 30 100 6.0 — 9,0 Note; if you reporl a sampled value In excess of the benohmark value, or outside the benohmark range for pH, you must lmplemonl Tier 1 or Tlor 2 responses, See General Permlt text, STORM EVENT CHARACTEWSTICS; Date / (first event sampled) V //Total Event Precipitation (inobes)t ! Data (list each additional event sampled this reporting patlod, and rainfall amount) Total Event Precipitation (inches), Mall Ortglnal and one copy to; Uivlalon of Water Quality Attn.- DWQ Central Flies 1617 Mail Service Contor Raleigh, Norih Carolina 27699.1617 S WU-249.102107 Pago 1 of2 I Li.kL---,A " Y certify, under penalty of law, that this dooumeat and all attachments were prepared under my direction or supervision in accordance with it system designed to assure that qualified personnel properly gather and evaluate the Information submitted, Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. Y am aware.that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations" (Signature of Permittee) (Date) SWU•249-102107 Page 2 of 2 6iivirochem - ANALYTICAL & CONSULTING CHEMISTS House of Raeford Post Office Box 40 Rose Hill NC Attention: Joe Teachey Lab ID Sample ID: 18-53561 Site: fmol Environmental Chemists, Inc. 6602 Windmill Way, Wilmington, NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax 710 Bowsertawn Road, Manteo, NC 27954 • 252.473.5702 Lab/Fax 255-A Wilmington Highway, jacksonville, NC 28540 • 910.347.5843 Lab/Fax info@environmentalchcn ists.com Date of Report: Jan 10, 2019 Customer PO #: 28458 Customer ID: 08100079 Report #: 2018-21276 Project ID: Stormwater Collect Date rime Matrix Sampled by 12/21/2018 1:35 PM Water Client Test Method Results Date Analyzed Dry Dry No Sample Lab ID Sample ID: Collect DatelTime Matrix Sampled by 18-53562 Site: FM2 12/21/2018 1:40 PM Water Client Test Method Results Date Analyzed Oil & Grease (O&G) EPA 1664 <5 mg1L 01/08/2019 Residue Suspended (TSS) SM 2540 D 18.6 mg/L 12/24/2018 pH SM 4500 H 8 6.60 units 12126/2018 COD SM 52200 116 mg/L 01/03/2019 Comment Reviewed by: kLM)Q-'Q_ RepoPt tt_ 2o18-21276 Paoo 1 of 1 mow ENVIRONMENTAL CHEMISTS, INC OFFICE: 9ID-3 2-0223iFAX 9t10.3 2-44245 NCDENR: DWO CERTIFICATION # 94 NCDHHS: OLS CERTIFICATION 4 37729 Info@envlronmentalchomiste.com Analytical & Consulting Chemists COLLECTION AND CHAIN OF CUSTODY Client: douse of Raeford PROJECT NAME: Stormwater REPORT NO: ADDRESS: CONTACT NAME: PO NO: REPORT TO: PHONE/FAX: COPY TO:Chris Murray email: Sampled By: SAMPLE TYPE: I = Influent, E = Effluent, W = Well, ST = Stream, SO = Soil, SL = Sludge, Other: Sample Identification Collection OMM' 1009Y.-TEMT-METU�= ANALYSIS REQUESTED 8188811 Bill I MOM �ME.Pro�m"73MMEpto�lloilll,COD,TSS,O&G,pH W7 mill Temperature when Received: jj., V r Accep Resampl*Reue ted:Delivered By: eceived By: Date: Comments: _OUND: SEMI-ANNUAL STORMWATER DI LARGE MONITORING REPORT for North Carolina Division of Water Quality General Permit No. NCGO6000O Date submitted CERTIFICATE OF COVERAGE �,� � GEE ,,NO. NCGO6-0 �n FACILITY NAME "".rFm;LCriuA COUNTY �� a= C__ PERSON COLLECTING SAMPLES 'rl ,, J LABORATORY 2Lx b Cert. # ?. NG oil Part A: Stormwater Benchmarks and Monitoring Results r p� SAMPLE COLLECTION YEAR o / I of ID FACILITY ACTIVITIES INCLUDE (check all that apply): OCT 2 2 2018 11 use/process meats ❑ use animal fats/byproduduNT RAL DISCHARGING TO SALTWATERS? []YES D&NO QWR eCTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4 Total event rainfall z or ❑ No discharge this period? Outfall No. Sample Collected, mo/dd/yr TSS, pH, Standard units COD, m L Oil and Grease, m L Fecal Coliform , Colonies per 100 ml Enterococcl , Colonies per 100 ml Benchmark - 100 or SO Within 6,0 - 9.0 120 30 1060 S00 46 7 6 r ,� iu =• _n T 1 Only applies to facilities that use/process meats. "~'Y ""L t-I1_3=5 2The total precipitation must be recorded using data from an on -site rain gauge. CWR SECTION 3 For sampling periods with no discharge at My outfalls. You must still submit this discharge monitoring report with a checkmark here. °See General Permit text, Table 3, Identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes Ono Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gat of new motor oil/month. Outfall No. Sample Collected, mo/dd r Oil and Grease, m L TSS, mglL pH, Standard units New' Motor Oil Usage, Annual average gal/mo Benchmark - 30 100 or 50 6.0 — 9.0 - Only applies to facilities that use/process meats. The total precipitation must be recorded using data from an on -site rain gauge. ' For sampling periods with no discharge at any. outfalls, you must still submit this discharge monitoring report with a checkmark here. 'See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. (i yg& complete Part Bj SWU-249 Last Revised: October 18, 2012 Page 1 of 2 ,*FOR PART At PART B MONITORING RESULTS: • • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART If 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 oriainal,and one copy of this DMR, lncludina all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitorina period in the case of "No Discharge" reports) to: Division of Water Quality Attn: DWQ Central files 1617 Mail Service Center Raleigh, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." D IgzzL (Date) Additional copies of this form may be downloaded at: httpjjportai.nccienr.org/web/­wg/ws/­suinpdessw#tab-4 SWU-249 Last Revise& October 18, 2012 Page 2 of 2 Analytical Results STATESVILLE ANALYTICAL Bay State Milling Co. Post Office Box 358 Mooresville, NC 28115 Receive Date: 09272018 Reported: 10/042018 For: Stormwater Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 180927-16-01 Chemical Oxygen OF#1 39 mg/L "AUMMM 10/01/2018 CL Demand 1S0927-18-01 Oil and Grease OF#1 7.75 mg/L E?A1564RevB 10/032018 CL 180927-16-01 TSS OF#1 9.667 mglL SM254OD-2011 09/28/2018 WC 180927-16-02 Chemical Oxygen 017#2 37 mg/L "ACHS= 10/012018 CL Demand 180927-16-02 Oil and Grease OF#2 <5.41 mg/L EPA1864Rer9 10/03/2018 CL 180927-16-02 TSS OF#2 12.333 mg/L SMA254062011 09/282018 WC Respectfully submitted, Dena Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page f of 3 r Condition of Receipt Sample Number 180927-16-01 Temp on Arrival: 2.3 pH on Arrival: <2 Parameter Schedule: Oil and Grease Hydrochloric Acid Received on Ice Chemicals in containers, lab Parameter Schedule: TSS Received on Ice pH on Arrival: <2 Parameter Schedule: Chemical Oxygen Demand Sulfuric Acid Received on Ice Chemicals in containers, lab Sample Number 180927-16-02 Temp on Arrival: 2.3 pH on Arrival: <2 Parameter Schedule: Oil and Grease Hydrochloric Acid Received on Ice Chemicals in containers, lab Parameter Schedule: TSS Received on Ice pH on Arrival: <2 Parameter Schedule: Chemical Oxygen Demand Sulfuric Acid Received on Ice Chemicals in containers, lab PO Sox 228 • Statesville, NC 28687. 704/872/4697 Page 2 of 3 GI ent: t • l • r _ 1 SIA'MSVI1,I.FANAI.Y9I AI. 122 Cain Street Ilt1. RM 22N Cmtmille, NC 211691 (704) 9724b47 Chain or Custody RivTo 'd Add • / V • r C Q r� / /� % V G Contact Person: f� �j Phone N F N r, ZS tJ PO N Requisitioned by: TqM Cuetom•r lion Pe 101 LA6.1O II Tlnw 9onvW (Omb anp) Delo 8•mplod Arab O 1 w r y„r l�urnNMa Rypcuod kw �narut SS w.02 Relinquished by: �— X Received by: Relinquishod by: Received by: - -- �.�mRla�it��lallne.�t1., Time begin r am,09 Date ,? 12 1 jS Timo and g am, Data l/' ��tnpoelta�fltnlalitts_N2c Time begin am, e) Date %_1*J��[•'�, Ttme and T—YS ar pr Date `�I�L�11� Time am, pm Date! �� Sampled by: Time am, pm Date �!Z l! V Transported by, Time am, pm Date ,_1_I,W.,. Holding times met: Timo am, pm Data J�I Compliance work: Non-compliance work: Lab Commonts: Samooa Trsnaportod on lee: � 1. % G , $— 7, 0 IniNnla: rn 00 00 N u tp IA N (U .bj M • 00 N N x 0 m 0 a SEMI-ANNUAL STORMWATER 1011I90ARGE MONITORING REPORT for North Carolina Division of Water Quality General Permit No. NCG060000 Date submitted 'F jza/ z CERTIFICATE OF OVERAGE NO. NCG06 9 .3 7 SAMPLE COLLECTION YEAR ,-Z I % FACILITY NAME .5 T4 Tf2 FACILITY ACTIVITIES INCLUDE (check all that apply): COUNTY �+�� 0 f^ c- _ ❑ use/process meats ❑ use animal fats/byproducts PERSON COLLECTING SAMPLES _ f _�A#1 DISCHARGING TO SALTWATERS't []YES [�INO LABORATORY STD mil//�� .d•ab CerL # ei S -O NC_ 4 ccJC ,eTr 3 77SS- rj' ,11.4 d1VC_ o q Part A: Stormwater Benchmarks and Monitoring Results RECEIVED AUG 18 2017 CENTRAL FILES DWR SECTION PLEASE REMEMBER TO SIGN 019 THE REVERSE 4 , ;L5 I-7t-Ar/pj Total event rainfall Ir.� or n No discharge this oeriodj Outfall No. Sample Collected, mo/dd/ r TSS, L pH, Standard units COD, mg/L Oil and Grease, mg/L Fecal Coliform , Colonies per 100 mi Enterococci , Colonies eer 100 ml Benchmark - 100 ar 50 Within 6.0 — 9.0 120 30 1000 Soo v4,9 2 r - l +� ? 1 Only applies to facllities that use/process meats. 2The total precipitation must be recorded using data from an on -site rain gauge. 3For sampling periods with no discharge at ity outfalis. You must still submit this discharge monitoring report with a checkmark here. 4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?[] yes �no Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month. outfall No. Sample Collected, mo/dd/ r Oil and Grease, L TSS, m L pH, Standard units New Motor Oil Usage, Annual avera e.gal/mo Benchmark - 30 100 or 50 6.0 — 9.0 - Only applies to facilities that use/process meats. ' The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at jU outfalls, you must still submit this discharge monitoring report with a checkmark here. 4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. (if n complete Part 8) SWU-249 Last Revised: October 18, 2012 Page l of 2 *FOR PART Ago 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 ❑ NOZ IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an orl anal and one c9gy of this DMR Including all "No Dlschar e" reports within 3D d s o revel t o the lab results or at end o monitorin eriod 1n the case o "No Dischar e" re arts to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY IIIIFORMATION REPORTED: "l certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." of (Date) Additional copies of this form may be downloaded at: http://portal.nc:denr.orp,/webjwci/ws/su/npdessw#ta_b-4 SWU-244 Last Revised: October 18, 2012 Page 2 of 2 Analytical Results Bay State Milling Co. Post Office Box 358 Mooresville, NC 28115 Receive Date: 07/31/2017 Reported: 08/04/2017 For: Comments: Sample Number Parameter Sample ID Result Unit Analyzed Analyst 170731-12-01 Chemical Oxygen OF1 81 mg/L H1GHB400'-` 08/03/2017 CL Demand 170731-12-02 Chemical Oxygen OF2 99 mg/L HACH8000 08/03/2017 CL Demand Respectfully submitted, Dena Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 2 Bay State Milling Co. Post Office Box 358 Mooresville, NC 28115 Receive Date Reported For: Comments: Analytical Results 07/1012017 07/ 19/2017 Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 170710-25-01 Ammonia Nitrogen #1 0.56 mg/L SM4500NH3E-1997 07/14/2017 MD 170710-25-01 Oil and Grease #1 <5.05 mg/L EPA1664RevB 07/18/2017 CL 170710-25-01 TSS #1 6.470 mg/L SWWD-1997 07/14/2017 WC 170710-25-02 Ammonia Nitrogen #2 <0.5 mg/L SM450ONH3E-1997 07/14/2017 MD 170710-25-02 Oil and Grease #2 5.39 mg1L EPA1664RevB 07/18/2017 CL 170710-25-02 TSS #2 <3.333 mg1L SM2WD-1997 07/14/2017 WC Respectfully submitted, &'�jy-ht, Dena Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 3 Condition of Receipt Sample Number 170710-25-01 Temp on Arrival: 3 Parameter Schedule: Oil and Grease Hydrochloric Acid Received on Ice Chemicals in containers, tab Parameter Schedule: TSS Received on Ice Parameter Schedule: Ammonia Nitrogen Sulfuric Acid Chemicals in containers, lab Received on Ice Sample Number 170710-25-02 Temp on Arrival: 3 Parameter Schedule: Oil and Grease Hydrochloric Acid Received on Ice Chemicals in containers, lab Parameter Schedule: TSS Received on Ice Parameter Schedule: Ammonia Nitrogen Sulfuric Acid Chemicals in containers, lab Received on Ice PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 2of3 Client: tirATF:.tiYII.I.F ANAI.YTI('Al. 122 Coun Street • P.O. Bin 228 $IAC%vllle. NC 211h1i7 (7(W I K72.4697 Chain of Custody Record Addr - Contact Person: Phone A FAX# 2� PO N Requisitia ed (Turw oath) C.uawso, Sample 10a tab -it) rr Una Sampled (Grab 0*) Date Sampled (Grab Only} Malrla w I VM Pare molars roquesiW ltk snalyaia �707 -25 1 1 Al r" Relinquished by: ,� by: Received L Relinquished by: l i,. Received by: horn o� site s�?R�9�.: Time begins% d am, ep Date Z/ q /f� Time end ,JE! ` p am, 0! Date _7 t!17 CamP981te_Sati12110g N2: Time begin j = f/Ife m, n Date 7—1 k 11 % Time end i.Svam, rr Date ,21 -1-7 Timej'� pm Da7/, ti�C:1. Time ' < <%', Amy m Date ]_1�L � p 1 Time am, pm Date _l,l r Time am, pm Date _/ Lab rAwrMnls! z z Sampled by: Transported by: Holding times met: -� Compliance work: Non-compliance work: I,- 00 kD 00 N u z Ci aJ 00 N N X O rn 0 a M O CO O x N N 00 V a M 00 M 00 N V O0 rV n� A C) lD V Client: A Itv STAMSVILL!( ANALYTICAL 12-1Coun Stroel • Y.O. [lox 228 Staiarilk,l+lC 29687 (704) R724697 Address: b} PN ? %J� /) eO0 Al�('s v!� !! - --t0 d Chi or Custody Record Pt) A Requieitiane(! Crime Date) Customer Semple Of Lab• O 4 e 6rmpieq Grab On Dale SamPlW Grab Oro l Walrlx w No ParBrr*"la requartad for andon 1 -12 r Relinquished by: s'/ T 112 2���-- Received by Relinquished by: Received by: ---- - _ .&Samolina 01: Time beginz?-! � am,�r Dale Z/� I[ r� Time end ��% am, r) Dale JI r r t;DMgQsite BanlGlina #2* Time begin iprr%am,&Date l! aL lc.I Time and ' O am, r& Date -i—1 i p1 Tlme It pm Date 73� �� Sampled by: Time !. i t " Date -71. �r -_c Transported by: Time am, pm Date ^/ / Holding times met: Time am, pm Date �/�� - Compliance work: Non-compliance work: Late Comments. Y� 0 ! 6 r//r C 2 `p<*S %��} 2— to' • 2— r s. SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT for North Carolina Division of Water Quality General Permit No, NCG060000 Date submitted 3f % Z/7 CERTIFICATE OF CRVERAGE NO. NCG06-011-1 SAMPLE COLLECTION YEAR 90 / 77 FACILITY NAME 1�4`f STfi 7 A Udy 6 FACILITY ACTIVITIES INCLUDE (check all that apply): COUNTY REggjjZTrocess meats ❑ use animal fats/byproducts PERSON COLLECTING SAMPLES _J l o �.w CI4 m PliZ LL TO SALTWATERS? []YES KNO LABORATORY, A!5' V&L9 ANiS'Cl/rlab Cent. # 1{r{P MAR 0 9 2017 AIC-O kJ '4 39P PLEASE REMEMBER TO SIGN ON THE REVERSE 4 S�ENTRAL FILES Part A: Stormwater Benchmarks and Monitoring Results IMR SECT101,iirotol event rainfall2 +66 /V or ❑ No discharge this period' Outfall No. Sample Collected, mo/dd/ r TSS, m L pH, Standard units COD, mjjL Oil and Grease, mg/L Fecal Coliform , Colonies er 100 ml Enterococci , Colonies per 100 ml Benchmark - !00 or 50 Within 6.0 - 9.0 120 30 1000 Soo a ,< I ,z , ' Only applies to facilities that use/process meats. z The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at an outfalls. You must still submit this discharge monitoring report with a checkmark here. °See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no (ifyes, complete Part B) Part 6: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month. Outfall No. Sample Collected, mo/dd/ r Oil and Grease, miji. TSS, m L PH, Standard units New Motor Oil Usage, Annual average gal/mo Benchmark - 30 100 or 50 6.0 - 9.0 - Only applies to facilities that use/process meats. 2 The total precipitation must be recorded using data from an on -site rain gauge. 3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here. °See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. SWU-249 Last Revised: October 18, 2012 Page i of 2 *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 ANYONE OUTFALL? YES ❑ N0� IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO REGIONAL OFFICE CONTACT NAME: Mall an orlgfnal and one copif of this DMR Including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitorina period In the case o "No Dischar e" re orts to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Permittee 3117,1,12 (Date) Additional copies of this form may be downloaded at: htto:Lportal.nccienr.org,/web/wnlws/su/npdessw#tab-4 SWU-249 Last Revised: October 18, 2012 Page 2 of 2 Analytical Results Bay State Milling Co. Post Office Box 358 Mooresville, NC 28115 Receive Date: 02/15/2017 Reported: 02/27/2017 For: Stormwater Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 170215-21-01 Chemical Oxygen #1 OF 50 mg/L HACH8000 02/16/2017 Cl_ Demand 170215-21-01 Oil and Grease 91 OF <5.18 mg/L EPA1664Reva 02/24/2017 CL 170215-21-01 TSS #1 OF 62 mg/L SM W[4 -7997 02/17/2017 CR 170215-21-02 Chemical Oxygen #2 OF 29 mg/L HACH8000 02/16/2017 CL Demand 170215-21-02 Oil and Grease #2 OF <5.21 mg/L EPA16&RevB 02/24/2017 CL 170215-21-02 TSS #2 OF 7.619 mg/L SM254061997 02/17/2017 CR Respectfully submitted, Dena Myers NC Cert #440, NCDW Cert #37755, EPA #NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 3 O w 0 x N N 00 to m ro rn z n N 00 rn 00 V — —.� ... ��. . AttiA1.1"1'If'Al. 122 Gwiil SI vo VO. fin. '_M 01111.7244-47 Address: p �J / r S M,4O QL'fs V 4iu y l --2C // - Contact Porson: phrv7 �C— Plron_� e 0 /, • FA XII � � /'� Chain of Custody Record PO r7 , Poquisitioned by: nw l CAM&~ SwigM OD r Letr IR r I wM swrq"1 Irk V"h'1 _ WIa Sk N*.d IGrab o oo Wirl. Pwwn*Wm m%XmW la N4*M _. +w' 11 215.2 -0 a r -% C o — S V 21 - - I 67 Relinquished by: Received by: / Relinquished by: Received by: I A L� .� �.-� .-- Time beginrr pm Date z�L/�0-1-7 Time end— •%� pm Dale 1 1IE �7 Commits�Sampling13: Time beging'L`aw, pm Dale J�I-W-O Time end jA ®, pm Date �- 1/) 117 Time am�7m Dale G,0 Time am, pm Date _I_1_ Time am, prn Dale Timeern, ern bate LI l-a6 co,r,rr,ume— it N fD' a ' • 7 Sampled by: � L Transported by: Holding limes met: r Compliance worts: Nan -compliance work: "I. \