NCG080143_MONITORING INFO_20190115

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
V cob
DOC TYPE
El HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ d D 1 0) %!�-Q
YYYYMMDD

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted 01/08/19
CERTIFICATE Of COVERAGE NO. NCGO80143
FACILITY NAME Pilot 56
COUNTY Cabarrus
PERSON COLLECTING SAMPLES KAH
LABORATORY _SGS Lab Cert. #f _346
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2018
SAMPLE PERIOD ❑ Jan June ® July -Dec
or ❑ Monthly' (monthl
�� � RIGi� 0 CLASS ❑ORW ❑HQW ❑Trout ❑PNA
R []zero -flow ❑Water Supply ❑SA
JAN 15 Z013 ❑other
GENTRAi FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
17WR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (if applicable)
yes _x_no
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 200 see permit
Within 6.0 -- 9.0
15
-
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.o — 9.0
001
12/20/28
1 <5.0
20.5
7.86
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11, 2013
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date _12/20/18 (first event sampled)
Total Event Precipitation (inches): _>0.1
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: !f you report a sample value in excess of the benchmark, you must implement rier I, Tfer 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 It 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
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES [j NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one coey o
i this DMR includin all "Na Discha e" reports, within 30 da a receipto the !a6 results or at end o monitoringperiod in
the case a "No Dischar e" re arts to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Date) T
Additional copies of this form may be downloaded at: http:llportal.ncdenr.org/wtblWct/ws/sujnpdessw#tab-4
S WU-250 last revised April 1], 2013
Page 2 of 2

_SGSr
Dayton, NJ
The results set forth herein are provided by SGS North America Inc.
'Technical Report for
Pilot Travel Centers LLC
ACVAR: #56, 2825 Lane Street, Kannapolis, NC
SGS Job Number: JC80221
Sampling Date: 12/20/18
Report to:
Apex Companies, LLC
7724 Garland Circle
Roanoke, VA 24019
[e-mail]
TTN: Robert Wagner
Total number of pages in report: 14
Test results contained within this data package meet the requirements
of the National Environmental Laboratory Accreditation Program
and/or state specific certification programs as applicable.
e-Hardcopy 2. D
Automated Report
B n McGuire
General Manager
Client Service contact: Tammy McCloskey 732-329-0200
Certifications: NJ(12129), NY(10983), CA, CT, FL, IL, IN, KS, KY, LA, MA, MD, ME, MN, NC,
OIf VAP (CL0056), AK (UST-103), AZ (AZ0786), PA, RI, SC, TX, UT, VA, WV, DoD ELAP (ANAB L2248)
This report shall not be reproduced, except in Its entirety, without the written approval of SGS.
Test results relate only to samples analyzed.
SGS Norih America Inc. • 2235 Route 130 • Dayton, NJ 08810 • tel: [phone] • fax: [phone]
1 of 14
SGS is tht: sole authority fN authorizing edits m modificatinns to this document. please share yout ideas abom —[%�S
Unauthorized omdilication oflhis report is strictly prohibited, how we c:ur serve you better at: O
Rey iLw sT<uxlard terms at: Irtq�:l��v�t�v.sgs.cottt/en/terns;-and-citnditirins I;I[S,lJS.f_'ustoni�:i[:arer;sgs.cnrn r-
JC60221

Table of Contents
Sections:
_1_
Section1: Sample Summary...................................................................................................
3
Section 2: Case Narrative/Conformance Summary..............................................................
4
Section3: Summary of Hits....................................................................................................
5
Section4: Sample Results........................................................................................................
6
4.1: JC80221-1: OUTFALL #001........................................................................................
7
Section5: Misc. Forms............................................................................................................
5.1: Chain of Custody...........................................................................................................
S
9
Section6: General Chemistry - QC Data Summaries..........................................................
6.1: Method Blank and Spike Results Summary .............................. ...............
.1.1
12
6.2: Duplicate Results Summary..........................................................................................
13
6.3: Matrix Spike Results Summary.....................................................................................
14
2of14
_SG8,.
JC80221

SGS North America Inc.
Sample Summary
Pilot Travel Centers LLC
Job No: JC80221
ACVAR: #56, 2825 Lane Street, Kannapolis, NC
ample Collected Matrix Client
dumber Date Time By Received Code Type Sample ID
JC86221-I � 12/20/18 15:50 KAH 12/21/18 AQ Water
'4UTFALL #001
����� 3 of 14
Jcao221

CASE NARRATIVE / CONFORMANCE SUMMARY
Client: Pilot Travel Centers LLC Job No lC80221
Site: ACVAR: f#56, 2825 Lane Street, Kannapol is, NC Report Date 12/27/2018 12:57:34 P
On 12/21/2018, 1 Sample(s), 0 Trip Blank(s) and 0 Field Blank(s) were received at SGS North America Inc. at a maximum
corrected temperature of 2.9 C. Samples were intact and chemically preserved, unless noted below. A SGS North America Inc. Job
Number of JC80221 was assigned to the project. Laboratory sample ID, client sample 1D and dates of sample collection are
detailed in the report's Results Summary Section.
Specified quality control criteria were achieved for this job except as noted below, For more information, please refer to the
analytical results and QC summary pages.
Compounds qualified as out of range in the continuing calibration summary report are acceptable as per method requirements when
there is a high bias but the sample result is non -detect.
General Chemistry By Method EPA 1664A
Matrix: AQ Batch ID: GP18276
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC79945-1DUP, JC80221-IMS were used as the QC samples for HEM Oil and Grease.
Matrix: AQ BatchID: GP18277
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC79945-1 DUP, JC80221-IMS were used as the QC samples for HEM Petroleum Hydrocarbons
General Chemistry By Method SM2540 D-11
Matrix: AQ Batch ID: GN89913
■ All samples were analyzed within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC80245-1 DUP were used as the QC samples for Solids, Total Suspended.
■ JC80221-1 for Solids, Total Suspended: Reported sample aliquot obtained from filtration of200 mL of sample. Volume was
reduced from 1 I iter due to nature of sample matrix.
SGS North America Inc. certifies that data reported for samples received, listed on the associated custody chain or analytical task
order, were produced to specifications meeting the Quality System precision, accuracy and completeness objectives except as noted.
Estimated non-standard method measurement uncertainty data is available on request, based on quality control bias and implicit for
standard methods. Acceptable uncertainty requires tested parameter quality control data to meet method criteria.
SGS North America Inc. is not responsible for data quality assumptions if partial reports are used and recommends that this report
be used in its entirety. Data release is authorized by SGS North America Inc indicated via signature on the report cover
Thursday, December 27, 2018 Page 1 of 1
4 of 14
JCBa221

Summary of Hits Page 1 of t
Job Number: JC80221
Account: Pilot Travel Centers LLC
Project: ACVAR: #56, 2825 Lane Street, Kannapolis, NC
Collected: 12/20/18
,ab Sample ID Client Sample ID Result/
►nalyte Qual RL MDL Units Method
JC80221-1 OUTFALL #001
Solids, Total Suspended e 20.5 4.0 mg/1 SM2540 D-11
(a) Reported sample aliquot obtained from filtration of 200 mL of sample. Volume was reduced from 1 liter due to
nature of sample matrix.
5of14
JCB0221

_SG9`
Daytor
Sample Results
Report of Analysis
Section 4
_S6of14
.Gg,-
JC60221

0
SGS North America Inc.
Report of Analysis Page 1 of 1
'lient Sample ID: OUTFALL 0001
,ab Sample ID: JC80221-1 Date Sampled: 12/20/18
4atrix: AQ - Water Date Received: 12/21/ 18
Percent Solids: n/a
'roject: ACVAR: #56, 2825 Lane Street, Kannapolis, NC
General Chemistry
Analyte Result
RL Units
DF Analyzed By Method
HEM Oil and Grease 5.6
5.0 mg/I
1 12/26/18 18:00 TM EPA 1664A
HEM Petroleum Hydrocarbons < 5.0
5.0 mg/I
1 12/26/18 18:20 TM EPA 1664A
Solids, Total Suspended a ' 20.5
4.0 mg/I
1 12/26/18 09:50 RC SM2540 D-11
(a) Reported sample aliquot obtained from
filtration of 200 mL of
sample. Volume was reduced from 1 liter due to
nature of sample matrix.
RL = Reporting Limit
_SG. 7ofi4
JC80221

SGS
Dayto.
' Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
Section 5
—��� 8 of 14
1..__ JC60221

Cnd __ a CHAINS OF CUSTODY
PAGE OF l
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1GCltzis.'La"�Z';ii;tli�!_'�.�11,.i�.'ll�.�t'laL'{:�:i�&5'Sd
r.-Monalcr—a.r:a'lym
JC80221: Chain of Custody
Page 1 of 2
w
J
c 9 o€14
—V
JC80221

SGS Sample Receipt Summary
Job Number: JC80221 Client:
Data 1 Time Received: 12/21/2018 1:00:00 PM Delivery Method:
Cooler Tamps (Raw Measured) •C: Cooler 1: (3.2);
Cooler Temps (Corrected) •C: Cooler 1: (2.9);
Cooler Security Y
1. Custody Seals Present: ®
or N
Q
Y or N
3, COC Present: ❑
2. Custody Seals Intact:
❑ 4. Smpl DateatTime OK [� ❑
Qoglar Temperature
1. Temp criteria achieved:
Y or N
® ❑
2. Cooler tamp verification:
IR Gun
3. Cooler media:
Ice (Bag)
4. No. Coolers:
1
Quality Control Preservation
1. Trip Blank present! cooler.
Y or N
❑ ®
NIA
❑
2. Trip Blank listed on COC:
❑ ®
❑
3. Samples preserved property:
® ❑
4. VOCs headspeca tree:
❑ C
Test Strip Lot fie: pH 1-12: 206717
Comments
Rev. Data 12W17
Project:
Alrblll ph:
SampleIntearity- DocuManfgtlon
1. Sample labels present on behlos:
Y
or_ N
2. Container labeling complete:
❑
3. Sample container label / COC agree:
®
❑
Sample Integrity . Condition
1. Sample recvd within HT:
Y
®
or N
❑
2. All containers accounted for:
®
❑
3. Condition of sample:
Intact
Sample Integrity - Instructions
1. Analysis requested Is clear.
Y
®
or N NIA
❑
2. Bottles received for unspecified taste
❑
3. Sufficient volume recvd for analysis:
�
❑
4. Composlting instructions clear:
❑
❑
5, Fihering Instructions dear,
Cl
❑ 66
pH 12+: 208717 Other: (Specify)
JC80221: Chain of Custody
Page 2 of 2
1 10 of 14
JC80221

-SUSt'-
Dayto
General Chemistry
QC Data Summaries
Includes the following where applicable:
• Method Blank and Blank Spike Summaries
• Duplicate Summaries
• Matrix Spike Summaries
Section 6
1�
—SG� __ �1 of 1b
JC80221

r
METHOD BLANK AND SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JCa0221
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: 456, 2825 Lane Street, Kannapolis, NC
MB Spike BSP BSP QC
Analyte Batch ID RL Result Units Amount Result %Recov Limits
HEM Oil and Grease GP18276/GN89970 5.0
HEM Petroleum Hydrocarbons GP18277/GNa9971 5.0
Solids, Total Suspended GN89913 4.0
Associated Samples:
Batch GN89913: JC80221-1
Batch GP18276: JC80221-1
Batch GP18277: JC80221-1
(') Outside of QC limits
0.0 mg/l
0.0 mg/1
0.0„ _ mg/1
Page 1
40.215 34.5 185.8 ! 7a-114%
20.135 14.8 73.5 64-132%
c(%$_ 12 of 14
_aU
JC80221

DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC80221
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: 956, 2825 Lane Street, Kannapolis, NC
QC Original DUP QC
Analyte Batch ID Sample Units Result Result RPD Limits
HEM Oil and Grease
GP18276/GN89970 JC79945-1 mg/1
111 107 3.7 0-18%
HEM Petroleum Hydrocarbons
GP18277/GN89971 JC79945-1 mg/i
20,0 27.1 3.3 0-34%
Solids, Total Suspended
GN89913 JC00245-1 mg/l
15.5 14.9 3.9 0-17%
Associated Samples:
0)
Batch GN89913: JC80221-1
jV
Batch GPI8276: JC80221-1
Batch 221-1
Outside o QC
(•) Outside of QC limits
•
Page 1
1 3of14
-SG$--
JC80221

MATRIX SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC00221
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: #56, 2625 Lane Street, Kannapolis, NC
QC Original Spike MS QC
Analyte Hatch ID Sample Units Result Amount Result BRec Limits
HEM Oil and Grease GP18276/GN89970 JC80221-1 mg/1 0.0 40.215 35.3 67.B ! 78-114%
HEM Petroleum Hydrocarbons GP18277/GN89971 JC30221-1 mg/l 0.0 20.135 15.4 I76_5 „ _ 64-132%
Associated Samples:
Batch GP18276: JCB0221-1
Batch GP18277: JC80221-1 GJ
(") Outside Of QC limits
(N) Matrix Spike Rec. outside of QC limits
•
Page 1
14 of 14
JC80221

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 7/5/18
CERTIFICATE OF COVERAGE NO. NCGO80143 SAMPLE COLLECTION YEAR tots
FACILITY NAME _Pilot 56 SAMPLE PERIOD ® Jan -June ❑ July -Dec
COUNTY Cabarrus G or ❑ Monthlyl (month)
PERSON COLLECTING SAMPLES RSW RECEN � ESISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
LABORATORY_SGS Lab Cert. # _346 �UL �01� ❑Zero -flow ❑Water Supply ❑SA
Comments on sample collection or analysis: ❑Other
D\NR S CTIO
PLEASE REMEMBER TO SIGN ON THE REVERSE -)
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable) ® No discharge this period'
Outfall
No:
Date
Sample Collected, `
mo/dd/yr ;;-:.
��530
w 00400, :
00556
Total Suspended . '
,,� Solids„mg/L :;;.
_pH, r :
Standard units ;
Non-Polary'O�I and�Grease/TPIiTEPA' "
.'- 'Methbi! 1664. (5GT-HEM) ;'m�L„
New fiAotor.Dii:Usage;
Annu l average,gal/mo;
Benchmark
.:
...��.
50 or 100�see permit
-Within69.0
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
Date
,00556> w
00530
w
00400�'
No. `"
Sam le`Collected;'''
.Non-PolarQiI i d Grease%TPH`EPA'IVlethod°
Total Sus niie�$5olids; ;,:
H ''
y
:mo/dd/Yr
x 1664'(SGT'HEIVI}, mg%L
r rng/L.,
::Standard units<
,,..
Permi#:.Ltm�t
¢:
K 5
`«i.; 15
�
w
50or"104see permit
9:0
001
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11, 2013
Page 1 of 2

STORWEVENT CHARACTERISTICS:
Date (first.event sampled)
Total Event Precipitation (inches):_
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation.(inches): .
!Vote: 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 tent
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERSTIERLA 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,QN.E 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 indudin all "No Dischar e" reports, within 30 days of receipt of the lab results or at end of monitorinrl period in
the case of 'No Discharge" reports) to:
Division of Water Quality
Attn: DWaCentral 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, thatthis 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 submittedis,:ta 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
7-57-
(Date)
Additional copies of this form may be downloaded.at: hft : ortal.ncdenr.o web w ws su n dessw#tab-4
S W U-250
last revised April 1 I.2013
Page 2 of 2

Semi-annual Storimwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted `41
CERTIFICATE OF COVERAGE NO. NCG08 O LL
FACILITY NAME Q
COUNTY
PERSON COLLECnNG SAMPLES
LABORATORY Cert. p
Comments on sample collection or analysis:
SAMPLE COLLECTIO YEAR
SAMPLE PERIOD gian-June ❑ July -Dec
❑ Monthly( (month)
��� GASSBORW ❑HQW ❑Trout ❑PNA
JUL 2 9 2015 ❑zero -flow ❑Water supply ❑sA
❑Other
CENTRAL FILES
oWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (d applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/'TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/ma
Benchmark
-
SO or 100 see permit
Within 6.0— 9.0
]3
-
,k
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00656
00530
004M
Non -Polar Oil and Grease/TPH EPA Method
1664 SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
SO or 100 see permit
6.0 — 9.0
(-LL
11 V
-C•
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
5WU-250 last revised April 11, 2013
Page l of 2
S

STORM EVENT CHARACTERISTICS:
Date �Lq 16 (first event sampled) !
Total Event precipitation (Inches): 4 ,. r
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Predpitation (inches):
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 ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES {] NO []
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cosy of this DMR including all "No Discharae" reports, within 30 don of receive of the lob results for at end of monitoring »eriad in
the case of "No Dischame"reoortsl to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted Is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significant penalties for subm"-faise informer ation, including the possoility of fines and imprisonment for knowing violations."
1P
(Signature of Penmittee)
��I15
(Date)
Additional copies of this form` may be downloaded at: http://portal.ncdenr.oEglweb/wq/w5lsu/nadessw#tab-4
S %VU-250
last revised April 11, 2013
Page 2 of 2

Ik
r ,
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.; �.y/ L?! .D or oeetlficate of Co No,: J C!!_1.l1131
Facility N Y S
County: one No.
Inspect— Dateof.
Date of lnspectlaa `.
By this signs , I certify th this report Is accurate a d qyNgete to the b of my knowlodge: ►'
5 atum of P=dmw or Deaf ee
( $n ) ,
L OtetiuA Uasariptian
WWI No, 0[) 1
Receiving Stream: R
Z6=14, the Industrial eo# dole that om within the ouaq drainage area:
r.
w r w
2. Color
` 1
Describe the color of the discharge using basic colors (red. brawn, blue, etc.) and tint (light, medium,
dark) as descriptors..
3. Odor
Describe anX o th_at the lac y have (LeL, amnlla strongly of oil, weak Chlorine odor, r !
etc.) �- i..t�—�7,
,
4. Clarlty
Choose the n imbsr which. but describes the;ladty of the discharge whore 1 is cleat' and 10 is very
cloudy.
1 3 4" w S 6 7 8 9 10
r
SWU-242-MMO
Page 1

f S. Fiaatfng Solids
Choose'the number which hest describes tiro amount of floating solids in the storrnwa u discharge where (•; �
I is no sollds and 10 is the surface covered with floating sonde:
f
►i 1 f 2 3 4 5 6 7 8 9 ID
6. Suspended Solids
9
v
Choose the number which beet describes the amount of soapendod solids in the stormwater discharge
where I to no solids and 10 is extremely muddy:
2 3 A S 6 7 8 Y 9 to
V �
7. Foam
Is there any foam in the stormwater discharge? Yea o
v r ,
8. OiLSheen ,
Is there an o!l sheen In the atarmwakau' disoharge7 Yes No 1
9. DtPosldon at MUM
Is there degositloa of nmter7al (se� etc.) at or immediawly below the outfall? Yea / jNo J
10. flroden at Q IWI
b `
Is there erosion at or immediately below the Duffel!? Yes
o .
T n '
11. o Other Obvious Wkmtore of Stormwater Pollution
Note: Low clarity, high agilds, andlor the presence of faan% oil sheen, deposition or erosion maybe
indicative of condittons that warrant ftuther investigation and corrective' action.
Page 2 .
S WU-242.020705

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Qua ity G neral Permit No. NCGO80000
Date submitted aQ % S'
CERTIFICATE OF C E NO. NCGT 0 lwlt SAMPLE COLLECTION YEAR 2 - •
SAMPLE PERIOD ❑ Jan -June my -Dec
M FACILITY NAE or Monthly' (month'
COUNTY DISCHARGING 7 CLASS ,ORW ❑HQW ❑Trout ❑PNA
PERSON COLLECTING AM S LABORATORY b Cert. #16 ❑Zero -flow ❑Water Su 1 pp y ❑S A
CRrqments on sampl collection or nal s: c ❑Other
fV0Ecd
l FF'sulo-
� PLEASE REMEMBER TO StGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes CIAO
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor oil Usage,
Annual average gal/mo
Benchmark
-
5D or 100 see permit
Within 6.0 — 9.0
15
-
Part B: Oil/water -;eparatoes and Secondary Containment Areas at � troleum Bulk arations and rierminals (if applicable!
Outfail
No.
Date
Sample Collected,
mo/dd/vr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
15
50 or 100 see permit
6.0 — 9.0
,..
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11, 2013
Page I of 2

STORM EVENT
-iCHARACTERISTICS:
Date 4F �rst event sampled] e
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: if you report a sample value in excess of the benchmark you must implement Tier 1, Tier Z, or Tier 3 responses See General Permit text.
FOR PART A AND PART 5 MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART It 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 ❑ NCI E]
IF YES, HAVE YOU CONTACTED THE D'WQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Moil an oriainal and one copy of this AMR Includinu all "No Discharge" reports, within 30 days of receipt of the lob results for at end of monitoring period in
the case of "No Discharge" reportsl 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. l am aware that
svaility or tines and imprisonment for knowing-6'olations.` ' -
Z- f -1 S-
(Date)
nf,grg/wehf, vg/: 5/suinpdess► # tab- 4
S W t i-?>0
last revised April 11, 2013
Page 2 of 2

x
I
{
i }
Pertnit No.: ' j IPd/j
Facility Name:
County.
Inspector.
Date of Inspebtion: _
By this signatw,F, i cc
w
�c
Stormwater Discharge OutfalI (SDO)
Qualitative Monitoring Report
6/010/0111 orCerUfloaleofCoveraseNo.: NICIO)
is accurate and complete to the best of my knowledge:
(5 ignature of Per nittce or Designee)
11 WWI Description
OuMl No, ," a (pi d c etc.) r
Recei�rtaStream: t
. ) smibe the industrial agtivitlea that occur within the outfall drainage area,
2. Color ,
Describe the color of the discrge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descrlplors., 1'?d.,.. _ .... ., ..
3. Odor
Describe any distirmt odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) off le
k
4, Clarity '
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
2 3 4" 5 6 7 8 9 e10
5 WV-242-020705
Page 1
M

:0 :j I_
S. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 Is no solids and 10 is the surface covered with floating solids:
i
2 3 0 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
wham 1 is no solids and 10 Is extremely muddy:
0 2 3 4 5 6 7 8 9 10 ,
7. Foam
Is there any foam in the stormwater discharge? Yes No }
8. Oil Sheen
Is there an oil sheen In the stormwater discharge? Yes
9. Deposition at Outhu
Is there deposition of metedat (sediment, etc,) al or Immediately below the outfall? Yes
10. Erosion at outfall
+ is there erosion at or Immediately below the outfall? Yes
11. Other Obvious Indicators of Storinwater )Pollutlon
List and describe �� t
Note,. Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may he
y indleative of conditions that warrant further investigation and corrective action,
Page 2
t SWU-242.020705

e-Hardcopy Z 0
Automated Report
EM Lafayette
ACCUTEST
LA DO R A T O R I ES
'Technical Report for
Pilot Travel Centers, LLC
DYNAMTNK:Pilot #056 2825 Lane Street, Kannapolis, NC
Accutest Job Number: LA14218
Sampling Date: 11/19/15
Report to:
Dynamis, Inc
P.O. Box 50636 3707 Henson Road
Knoxville, TN 37921
[e-mail]
ATTN: Emily J Wilson
Total number of pages in report: 14
Test results contained within this data package meet the requirements Ron Benj�in
of the National Environmental Laboratory Accreditation Program Lab Director
and/or state specific certification programs as applicable.
Client Service contact: Ralph Frye 337-237-4775
Certifications: LDEQ(2048), LDHH(LA150012), AR(14-045-04), FL(E87657), KY(#31), NC(487), SC(73004001),
TX(T104704186-15-7). WV(257)
This report shall not be reproduced, except in its entirely, without the written approval of Accutest Laboratories.
Test results relate only to samples analyzed.
Lafayette • 500 Ambassador Caffery • Scott, LA 70583 • teL [phone] • http://www.accutesi.com
Q
Accutest Laboratories is the sole authority for authorizing edits or modifications to this ■ 1 of 14
ACCUTEBT.
dc-cumcnt, Unauthorized modification of this report is strictly prohibited. LA14219 ........•.••

Table of Contents
-1-
Section1: Sample Summary........................................................................ ...........................
Section2: Summary of Hits....................................................................................................
Section3: Sample Results........................................................................................................
3.1: LA 14218-1: 001............................................................................................................
Section4: Misc. Forms............................................................................................................
4.1: Chain of Custody...........................................................................................................
Section 5: General Chemistry - QC Data Summaries..........................................................
5.1: Method Blank and Spike Results Summary ..................................................................
5.2: Blank Spike Duplicate Results Summary ......................................................................
5.3: Duplicate Results Summary ..........................................................................................
Sections:
3
5
6
7
8
11
12
13
14
0
0
0
0
I2 of 14
ACCUTEBT.
LA14I10 "'O"'"""

Accutest Laboratories
Sample Summary
Pilot Travel Centers, LLC
Job No: LA14218
DYNAMTNK:Pilot #056 2825 Lane Street, Kannapolis, NC
Sample Collected Matrix Client
Number Date Time By Received Code Type Sample ID
-LA14218-1 11/19/15 12:00
11/20/15 AQ Water 001
7
�■ T.3 of 14
^ccU7EB

Summary of Hits Page 1 of 1
Job Number: LA14218
Account: Pilot Travel Centers, LLC
Project: DYNAMTNK:Pilot #056 2825 Lane Street, Kannapolis, NC
Collected: 11/19/15
Lab Sample ID Client Sample ID Result/
Analyte Qual RL MDL Units Method
LA14218-1 001
Solids, Total Suspended 10.0 4.0 mg/l SM2540 D-11
pH (Field) �6.90 su SM4500H+B-11
I4 of 14
ACCUTEaM
LA14216 ............

Section 3
Lafayette
w ACCUTEST''
L A B OR A T O A I C S
Sample Results
Report of Analysis
0a 5of14
ACmu-reaT.
LA14218 ...... ""'

Accutest Laboratories
Report of Analysis
Client sample ID: 001
Lab Sample ID: LA14218-1 Date Sampled: 11/19/15
Matrix: AQ - Water Date Received: 11/20/15
Peroeat Solids: n/a
Project: DYNAMTNK:Pilot #056 2825 Lane Street, Kannapolis, NC
Page 1 of 1
General Chemistry
Analyte
Result
RL Units
DP Analyzed By Method
HEM Oil And Grease
< 5.6
5.0 mg/l
1 11/24/15 09:00 CS EPA 1664A
Solids, Total Suspended
-10.0
4.0 mg/l
1 11/24/15 09:35 Iv SM2540 D-11
Field Parameters
pH (Field)
6.90
su
1 11/19/15 12:00 SM4500H+13-11
RL = Reporting Limit
VW
a■ 6 of 14
ACCUTE9T.
LA14218 I..... ,�••

Section 4
■■
■ ,o.cc
0
i Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
tiJ
Q� 7 of 14
Akccu-reS7.
LAU218 ` ..........

2r9
SPL, INC.
Anafyds Roqued 6 Cha3n of Custody Record
SPL Vft*ardor No:
Flag* No.
df
Ow d NOW P11%Travel CWW
euraoc
WME
am
mas.
p
REOUEMD
ANALYSIS
Addmc 6606 Loney Rd.
'0
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#�
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Tl
aq
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g 6
a ■
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C
M
a
Adder Nroxvne. TN AP: 31`430-0145
Pfw WFax: 66S596716S
OWN Mama* Joey Woo
Emas:
Pmod Nameft "G-M
S6a Harm: PTC466
Xanrpo4. NC 29083
66e Loen'.in: 767b Lam BlrMetf
Irwoks To: PTC-M
!AMPLE iD
dllT!
GOM
OaM
001
r r
oo
❑
fl
w`
O
1
1
1
x
001
I.A:Q0
❑
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w.
P a
is
o
1
x
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
CienVCaneuxerd Raffwkr, FMdd pH:
DYNWS, INC Tons halls RaNds• Rah dope
we. , O D K3ytO
Ley
Wad? ❑ Y PrN
IN? ZY ON
«m: •5 D 2C1 u
Raquaand TAT
0 c4mad
SPKIW Repw" PAPAwnerae: ❑ Fax ❑ Emam ❑ PDF
❑ SWWmM OC ❑ U.* 3CC ❑ LAM 4 OC ❑ TXTRRP ❑ CAP
SPuad DeNCOM ' (SpecMyq
-ZA 2. 1 AZ
Cwbdy Sawn: ❑ Y N
Cooler. A ❑ N
lcoffuimr. Y ❑ N
Cl 24 hr
IBF1E❑ EY
DATE
TOSS
RECEIVED BY:
❑ ds hr
1. Sy "w4m ;
2. Raoslvad By.
❑ 77 fir Reoeiwd By: f
0 SWUM 6. alr C L 1! iveFL O 1S B RaoaMd BIr
❑ COW.
❑ 566011Ia1nhlxga Dd.s• MkMW% TX "OU El ph":
ArnMul a CaRery Ptwy Boon, LA "M
Phone: BaD• MMS Phone: 606104-aw
460 Hughes DdW. Traverse My. MI 4M0
❑ Phmo: MT766024
LA14218: Chain of Custody
Page 1 of 3
I8of14
ACCLITEST.
LA14216 `"a""""`

NpxLss 8079'0101 9104.
2 YewkMmeRi6I%S l raaw /� �G' S�L• ;�� •' c.• 5 5"•:
3 Ta �-
j
4 kxprw Pmd 3wAn •rr�
xen:a�rr.ww�w.rYAti..r`e.r+b '
y
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/.OPx3undvd 6r.mipa
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8^ Sp.ci�I xee�yaybytp.na o�tb.g tlp�o. apiL
M�wWr�� W.Ip.Malrr Yx�AM.xrit�..
s
I
1 � (y ,,�V•CS ti ,�����J
C..ury >..�^•
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�e nf�+gJi.d �fna �.
� nw"7i,7ww •r°'"1... � �r...,r"ir.'r�i. "r..,•"�`�ari'^°'�~ �; '
u..iw,r.wwfr.or
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O.r.6n �lom.nLaeeNedro•ras9..an j -,
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❑ b r..&C"
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4
LA14218: Chain of Custody
Page 2 of 3
Qa T.9 of 14
ACCU_rEB
LA14218 1..... ""

C• CCUTEBT. Accutest Laboratories Sample Receipt Summary
LAOOOATORidA
Accutest Job Number: LA14218 Client: PILOT TRAVEL CENTER Project: PTC-058
Data l Time Received: 11/2012015 9:20:00 AM Delivery Method: FedEx Airblll ore: 807001019304
Cooler Temps (Initial/Adjusted): #1' f1.5i1.41:
Cooler Security Y
1. Custody Seals Present: ❑
or N
®
Y or N
3. COG Present: ® ❑
2. Custody Seals Intact; ❑
®
4. Smpl Datealrime OK ® ❑
Cooler Temperature
1. Temp criteria achieved:
Y or
R
N
❑
2. Thermometer ID:
DV260;
3. Cooler media:
Ice {Bag}
4. No. Gaolers:
1
Quality Control _Prasarvatlon
Y
❑
or N NIA
❑
1. Trip Blank present 1 cooler.
2. Trip Blank listed an COC:
❑
❑
3, Samples preserved properly:
®
❑
4, VOCs headspace free:
C
❑
AxuW LaWaldrin
V.1900] 304-5227
Sample Intaorltv - Documentation
1. Sample labels present on bottles:
2. Container labeling complete;
3. Sample container label I COG agree:
Semple Integrity - Condition
1. Semple recvd within HT:
2. All containers accounted for:
3. Condition of sample:
Sample Integrity - Instructions
1. Analysis requested Is clear,
2. Bottles received for unspecified tests
3. Sufficient volume recvd for analysis:
4. Composillng Instructions dear.
5. Filtering instructions clear.
500 AmtMPO& CANery Pnkw Y
Y or N_
® ❑
® ❑
® ❑
Y or N
® ❑
® ❑
Intact
Swtt. Lwuk M 70W
LA14218: Chain of Custody
Page 3 of 3
a■ 10 of 14
ACCU-rE=-BT.
LA1421B ........r....

Section 5
EM Lafayette:,,,,
ACCUTEST '�;
LA DO R A T O R I US,
General Chemistry
QC Data Summaries
Includes the following where applicable:
• Method Blank and Blank Spike Summaries
• Duplicate Summaries
• Matrix Spike Summaries
©11 of 14
ACCU-rea-r
LA14218 `

METHOD BLANK AND SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: LA14218
Account: PILOTSS - Pilot Travel Centers, LLC
Project: nYNAMTNK:Pilot #056 2825 Lane Street, Kannapolis, NC
MB Spike BSP BSP QC
Analyte Batch lb RL Result Unite Amount Result %Recov Limits
HEM Oil And Grease GP2992/GN5536 5.0 0.0 �mg/1 40 34.0 85.0 78-1144 (A
Solids, Total Suspended GN5594 4.0 0.0 mg/1 1000 998 99.8 9o-110k :.L
Associated Samples:
Batch GN5594: LA14218-1
Hatch GP2992: LA14218-1
(*) Outside of QC limits
Page 1
I12 of 14
ACCU7EBT.
LA14118 L..... 1..

BLANK SPIKE DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: LA14218
Account: PILOTSS - Pilot Travel Centers, LLC
Project: DYNAMCNK:Pilot #056 2825 Lane Street, Kannapolis, NC
Spike BSD QC
L,-.:Lyte Batch ID Unite Amount Result RPD Limit
HEM Oil And Grease GP2992/GN5536 mg/l 40 32,0 6;1 20t
Associated Samples:
Batch GP2992: LA14218-1
f'1 Outside of QC limits
Page 1
f
©13 of 14
ACCWTEBT
LA14215 """"""""

DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: LA14210
Account: PILOTSS - Pilot Travel Centers, LLC
Project: DYNAMTNK:Pilot #056 2825 Lane Street, Kannapolis, NC
QC original DUP QC
Analyte batch ID Sample Units Result Result RPD Limits
Solids, Total Suspended GN5544
Associated Samples:
Batch GNS544: LA14218-1
(') Outside of QC limits
LA14313-1 mg/l 550 510 ' 7.5 0-20t
w
W
Page 1
14 of 14
Q ACCUTEBT.
LA14218

IDUnamls,Inc.
P.Q. Box 50636, Knoxville, TN 37950
Phone: [phone] Fax: [phone]
December 17, 2015
ATTN: Central Files
Division of Water Quality
NC DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
RECEIVED
DEC 18 [ul�
CENTRAL FILES
DWR SECTION
RECEIVED
Transmitted via Federal Express #: 7752 3467 2945
DEC 18
CENTRAL. FILES
DWR SECTION
RE: Discharge Monitoring Report (DMR) — Semi -Annual #2 2015
NPDES #NCG080143
Pilot Travel Center, Store #056
Kannapolis, NC
Dear Sir or Madam:
I have enclosed a copy of the semi-annual DMR for the second half of 2015. If you have
any questions concerning this report, or if I can be of assistance in any way please feel
free to contact me at 865-588-5422 ext. 208 or at [e-mail].
Sincerely,
Alan Fass
Environmental Manager
Dynamis, Inc.
Enclosure: One original and one copy of the semi-annual #2 2015 DMR.
cc: Joey Cupp, Environmental Manager, Pilot Travel Centers LLC, 5508 Lonas Drive,
Knoxville, TN 37909
Keith Carlton, Environmental Project Manager, Pilot Travel Centers LLC, 5508
Lonas Drive, Knoxville, TN 37909