NCG080428_MONITORING INFO_20190115

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
�VC�(��'-f2'�
DOC TYPE
El HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ o1D (q( 1 IS
YYYYMMDD

10
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted
CERTIFICATE OF COVERAGE NO. NCGO80428
FACILITY NAME Pilot 7971
COUNTY Catawba
PERSON COLLECTING SAMPLES HC
LABORATORY— _,SGS Lab Cert. it 346
Comments on sample collection or analysis:
01/08/19
SAMPLE COLLECTION YEAR 2018
"DOD ❑ Jan June ® July -Dec
ttQ�
or ❑ Monthly' (month)
JAN &iliRAING TO CLASS ❑ORW ❑HCtW ❑Trout ❑PNA
CENTRAL FILES ❑Zero -flow ❑Water Supply [:]SA
OWR SE3TION ❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facifity perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes _x_no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
El 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 100 see permit
Within 6.0— 9.0
15
-
Part 8: 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 Aids,
mg/L
pH;
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
001
10/26/18
<5.0
37.8
5.50
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 _10/26/18 (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: If you report a sample value in excess of the benchmark, you must Implement Tier 1, Tier 2, or Trer 3 responses. See General Permit text.
FOR PART A AND 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:
Mail an original and one copy of this DMR, including all 'No Discharge' reports, within 30 days of receipt of the lab results for at end of monitoring period in
the case of "No Discharge" r�rtJs_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 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."
/—e`l,?
(Date)
Additional copies of this form may be downloaded at:.http://Portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250 last revised April 11, 2013
Page 2 of 2

G
Dayton, NJ t .
The results set forth herein are provided by SGS North America Inc.
Technical Report for
Pilot Travel Centers LLC
ACVAR: #7971, 1343 Rack Barn Road, Conover, NC
SGS Job Number: JC76808
Sampling Date: 10/26/18
Report to:
Apex Companies, LLC
7724 Garland Circle
Roanoke, VA 24019
[e-mail]; andrew.street@apexcos.
ATTN: Robert Wagner
Total number of pages in report; 15
e-Hardcopy 2.0
Automated Report
r .0
Test results contained within this data package meet the requirements aul loannidis
of the National Environmental Laboratory Accreditation Program General Manager
and/or stale specific certification programs as applicable.
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,
OH VAP (CL0056), AK (UST-103), AZ (AZ0786), PA, RI, SC, TX, UT. VA, WV, DoD ELAP (ANAS 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 North America Inc. • 2235 Route 130 - Dayton, NJ 08810 • tel: 732.329.OZOO • fax: [phone]
SCis is the Sole authority A€€ authorizing edits or niodiPictttions to this ductunela. Please shove your ideas about �r
Unauthorizcd ntodilicaGott of This rcpint is strictly htohihilcd. how %vc cmt serve you better at: u
Itevictt standard tenus at: Irttp:lht»wsgr'.cixtticnRernts-and-conditiiim I:11S.US,CuslomerCare, sgs.com Sr-
1 of 16
JC76808

Sections:
Table of Contents
_1_
Section1: Sample Summary..................................................................................................
3
Section2: Case Narrative/Conformance Summary..............................................................
4
Section3: Summnan, of Flits....................................................................................................
5
Section4: Sample Results........................................................................................................
6
4.1: 3C76808-1: O W S-1......................................................................................................
7
Section5: Misc. Forms............................................................................................................
5.1. Chain of Custody............................................:..............................................................
8
9
Section 6: General Chemistry - QC Data Summaries..........................................................
6.1: Method Blank and Spike Results Summary..................................................................
12
13
6.2: Duplicate Results Summary..........................................................................................
14
6.3: Matrix Spike Results Summary.....................................................................................
15
e 2of15
_a-U
JC76808

SGS North America Inc.
Sample Summary
Pilot Travel Centers LLC
Job No: JC76808
ACVAR: #7971, 1343 Rock Barn Road, Conover, NC
Sample `Collected Matrix Client
Number Date Time By Received Code 'type Sample ID
'JC76808-1 --10/26/18 15:15 HC 10/27/18 AQ Water OWS-1
0
-SG91-- 3 of 15
JC76808

CASE NARRATIVE / CONFORMANCE SUMMARY
Client: Pilot Travel Centers LLC Job No JC76808
Site: ACVAR: 07971, 1343 Rock Barn Road, Conover, NC Report Date 111612018 8:53:55 AM
On 10/27/2018, 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 1.7 C. Samples were intact and chemically preserved, unless noted below. A SGS North America Inc. Job
Number of JC76808 was assigned to the project. Laboratory sample ID, client sample ID 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: GP17093
■ All samples were prepared within the recommended method holding time.
• All method blanks for this batch meet method specific criteria,
■ Sample(s) JC76808-1 MS, JC76831-1 DUP were used as the QC samples for HEM Oil and Grease.
Matrix: AQ Batch ID: GP17094 1
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC76808-IMS, JC76831-IDUP were used as the QC samples for HEM Petroleum Hydrocarbons.
■ RPD(s) for Duplicate for HEM Petroleum Hydrocarbons are outside control limits for sample GP17094-DI. RPD acceptable
due to low duplicate and sample concentrations.
General Chemistry By Method SM2540 D-11
Matrix: AQ Batch ID: GN67693
■ All samples were analyzed within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC76827-SDUP were used as the QC samples for Solids, Total Suspended.
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
Tuesday, November 06, 2018 Page 1 of 1
4of15
_SGW.
JC76808

Summary of Hits Page 1 of 1
Job Number: JC76808
Account: Pilot Travel Centers LLC
Project: ACVAR: #7971, 1343 Rock Barn Road, Conover, NC
Collected: 10/26/18
Lab Sample ID Client Sample 1D Result/
Analyte Qual RL MDL Units Method
JC76808-1 OWS-I
Solids, Total Suspended 37.8 4.0 mg/I SM2540 D-I1
_....SG9.. 5 of 15
JC76808

Dayton, NJ
Sample Results
Report of Analysis
Section 4
0
-SG9t- 6 of 15
rc766os

SGS North America Inc.
Report of Analysis
Client Sample ID: OWS-1
Lab Sample ID: JC76808-1 Date Sampled: 10/26/18
Matrix: AQ - Water Date Received: 10/27/18
Percent Solids: n/a
Project: ACVAR: #7971, 1343 Rock Barn Road, Conover, NC
General Chemistry
Analyte Result
HEM Oil and Grease < 5.0
HEM Petroleum Hydrocarbons < 5.0
Solids, Total Suspended 37.8
RL = Reporting Limit
Page 1 of
RL
Units
DF Analyzed By Method
5.0
mg/I
1 11/05/t8 14:30 'rM EPA 1664A
5.0
mg/I
1 11/05/18 14:50 TM EPA 1664A
4.0
mg/I
1 10/30/18 10:30 RC SM2540 D-1 I
7of15
_SG9

S-G�
Daytc
' Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
Section 5
.._....S.Gg,_ Sof15
JC766D6

CHAIN OF CUSTODY
W
8D9 North Amntca Inc. • Dayton
2236 Routs IX Dayton. NJ 001110
TEL. [phone] FAX 732_329,3499
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JC7b808: Chain of Custody
Page 1 of 3
9of15
_._..SG
JC76808

SGS Sample Receipt Summary
Job Number: JC76808 Client: APEX COMPANIES, LLC Project: ACVAR: #7871, 1343 ROCK BARN ROAD, CON
Date/ Time Received: 10/27/2018 10:00:00 AM Delivery Method: FedEx A(rb(II We:
Cooler Tomps (Raw Measured) IC: Cooler 1: (2.3);
Cooler Temps (Corrected) °C: Cooler 1: (1.7);
Cooler Security Y
1. Custody Seals Present: ®
or N
❑
3. COC Present:
2, Custody Seals Intact: ®
❑
4. Smpl Datearrime OK
foolerTemperature
1. Temp criteria acNeved:
Y or
®
N
❑
2. Cooler temp verification:
IR Gun
3. Cooler media:
Ice (Bag)
4, No, Coolers:
1
Quality Control Preservation
Y
❑
or IN
R
____NIA
❑
1. Trip Blank present I cooler:
2. Trip Blank listed on CM
❑
®
❑
3. Samples preserved properly:
(6
0
4. VOCs headspace free:
❑
0
Test Strip Lot #s: pH 1.12: 216017
Comments Please note limited volume of 2x 1000ml for PHC and O&G.
SMOBIW3
Rev. bete 1217N7
Sample Intearity - Documentatlon
1. Sample labels present on bottles:
2. Container labeling complate:
3. Sample container label! COC agree:
Sample Intearlty - Condition
1, Sample recvd Wlthln HT:
2. All containers accounted for.
3. Condition of sample:
Sample Intearlty - Instructions
1. Analysis requested is dear:
2. Bottles received for unspecified tests
3. Sufficient volume recvd for analysis:
4. Compositing instructions dear:
5. Filtering instructions dear:
pH 12+: 208717 Other: (Specify)
_Y or N
® ❑
® ❑
Y or N
® ❑
® ❑
Intact
Y or N NIA
® ❑
[]
® ❑
❑ ❑ Ed
❑ Cl
JC76808: Chain of Custody
Page 2 of 3
1 10of15
._.._SGSt-
JC7664a

Responded to by: CSR; NIA
Response Date; Response Dale: 1012912018
Response:
Response: Proceed Wth analysis
JC76808: Chain of Custody
Page 3 of 3
1 11 of 15
-SGS,-
JC788t78

Dayton, NJ
'General Chemistry
QC Data Summaries
Includes the following where applicable:
• Method Blank and Blank Spike Summaries
• Duplicate Summaries
• Matrix Spike Summaries
Section 6
n
_. SG!12 of 15
JC76906

METHOD BLANK AND SPIKE RESULTS SUMMARY
GENERAL CHEMMISTRY
Login Number: JC76808
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: #7971, 1343 Rock Barn Road, Conover, NC
MB Spike BSP BSP QC
Analyte Batch ID RI. Result Units Amount Result 4Recov Limits
HEM Oil and Grease GP17093/GN87959 5.0
HEM Petroleum Hydrocarbons GP17094/GN67963 5.0
Solids, Total Suspended GN87693 4.0
Associated Samples:
Batch GN07693: JC76BO8-1
Batch GP17093: JC76808-1
Batch GP17094: JC760G8-1
(*) Outside of QC limits
C.0
0.0
0.0
Page 1
mg/l 40.235 32.2 00.0 78-114%
mg/l 20.02 15.1 75.4 64-132%
mg/1
1 13of15
-.SGs,.
JC76806

DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC76808
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: #7971, 1343 Rock Barn Road, Conover, NC
QC original DUP QC
Analyte Batch ID Sample Units Result Result RPD Limits
HEM oil and Grease
GP17093/GNB7959 JC76831-1 mg/l 0.0
0.0 0.0 D-18%
HEM Petroleum Hydrocarbons
GP17094/GN81963 JC76831-1 mg/1 0.0
0.90 200.0 W 0-34%
Solids, Total Suspended
GN87693 JC76827-5 mg/1 2.9
2.9 0.0 0-17%
Associated Samples:
p�
Batch GN87693: JC76808-1
N
Batch GP17093: JC76808-1
Batch JC76808-1
o:
outside mits
(*) Outside of QC limits
•
(a) RPD acceptable due to low
duplicate and sample concentrations.
Page 1
SGS 1
14of15
��
JC76808

MATRIX SKKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC76808
Account: PILOTS$ - Pilot Travel Centers LLC
Project: ACVAR: 07971, 1343 Rack Barn Road, Conover, NC
QC Original Spike MS QC
Analyte Batch ID Sample Units Result Amount Result BRec Limits
HEM Oil and Grease GP17C93/GN87959 JC76808-1 mg/1 0.0 40.235 33.7 83.8 78-114%
HEM Petroleum Hydrocarbons GP17094/GN07963 JC76808-1 mg/1 1.0 20.02 15.6 72.9 64-132#
Associated Samples:
Batch GPI7093: JC76808-1 Qy
Batch GPI7094: JC76808-1
W
(•) Outside of QC limits
(N) Matrix Spike Rec. outside of QC limits
w
Page 1
_a_utw%gr-15 of 15
JC76808

w.
July 5, 2018
Division of Water Quality
Attention: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Discharge Monitoring Report — January to June 2018
Pilot #7971
1343 Rock Barn Road, NE
Conover, North Carolina
Permit NCG080428
Dear Sir/Madam:
C V ED
JUG 13 NIB
IFiL.ES
�WR CT10N
Attached is the January - June 2018 Discharge Monitoring Report (DMR) prepared for the above
referenced site. The laboratory analytical data for this round of sampling is also attached. If you
have any questions, please feel free to contact me at [phone].
Sincerely,
Robert S. Wagner
Program Manager
Attachments
cc: Melody Mayville, Pilot Flying J
Apex Companies, LLC - 7724 Garland Circle • Roanoke, VA 24019
T 540,563.4920 - F 540.563.4921 • apexcos.com

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. NCGO80428
FACILITY NAME _Pilot 7971
COUNTY Catawba
PERSON COLLECTING SAMPLES RSW
LABORATORY SGS Lab Cert. # _346
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2019
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow [—]Water Supply ❑SA
❑Other
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)
Part B: oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
No discharge this period'
Outfall .;
YNa
.
„r:::.
y ., Date.00400�s
'Sample,
P
mo/dd/yr -"
Non Polar0il a d Grease „ H EPA;Methotl;.
1664 (SGT-HEM); r.
•:: Tatal`Susended`Sohds,
P,<
Mg/Li
� ,
Standardauriits
Pe mif;fj tiit
-
= _
" d q°15
Oaa �see,perm t
0 9 0
001
6/12/18
<5.3
37.3
6.99
1 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 l of 2

STORM EVENT CHARACTERISTICS
Date _6/12/18 (firstevent sampled)
Total Event Precipitation (inches): ><0.1
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 implem6nt Tier 1, rJer 2, orVer 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 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 ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy. of this DMR . indudin2all "No Discharge" reports within 360M, of receipt of the lab results torat end_of monitoring period in
the case-91 No Discha e" re orts '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'IN FORMATION' REPORTED:
"I certify, under'penalty of law, that this documerit and'all attachments were`peepared under my direction'oe supervision_in accordance' with a system designed to'assure
that qualified personnel properly gather and evaluate the iiif6rMation submitted. Based on my inquiiy'of the:person or persons WK6 maiiake the system, or those. -persons
directly responsible for gathering;the information; the information subniitted'is,to the best of mykhowledge and belief, true; accurate, and complete: I am aware that
there are.significant penalties,for submitting false information, including gthe possibility of fines and.imprisonment for knowing violations_'
(Signatureof
(Date)
Additional copies of this forrri may be downloaded at: tittp:IlAortaLricilen_r.ar/web/wq(i+vs/su/nndessw#tab-4.
.SWU-7-51i
last -revised April 11. 2013
Page 2 of

Dayton NJr;
The results set forth herein are provided by SGS North America Inc. e-Hardeopy 2.0
Automated .Report
[Technical Report for '
Pilot Travel Centers LLC
ACVAR: #7971, 1343 Rock Barn Road, Conover, NC
SGS Job Number: JC67942
Sampling Date: 06/12/18
Report to:
Apex Companies, LLC
7724 Garland Circle
Roanoke, VA 24019
[e-mail]; andrew. street@ apexcos.
ATTN: Robert Wagner
Total number of pages in report: 14
7
U
Test results contained within this data package meet the requirements Nancy Cole
of the National Environmental Laboratory Accreditation Program Laboratory Director
and/or state specific certification programs as applicable.
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,
OH 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 North America Inc. - 2235 Route 130 - Dayton, NJ 08810 - lel: 732-329-0200 - fax: [phone]
Si;S is the side authority Rir authorizing, edils or modifications to this document. Please share your ideas about [�/�
Unauthorizcd nurditicalion of this rel7A is strictly prohihil d, how we can serve you better at: —au
$-
Review standard terms at: httl3:11wvr w,sgs.cnrnleniterms-and-conditions f'_I i5.115.CustomerCarerr%sgs.com
1 of 14
JC67942

Sections:
Table of Contents
-1-
Section1: Sample Summary................................................................................................... 3
Section2: Case Narrative/Conformance Summary.............................................................. 4
Section3: Summary of Hits.................................................................................................... 5
Section4: Sample Results........................................................................................................ 6
4.1: 7C67942-1: OWS 7971................................................................................................. 7
Section S: Misr. Forms............................................................................................................ 8
5.1: Chain of Custody.......................................................................................................... 9
Section 6: General Chemistry - CSC Data Summaries.......................................................... 11.
6.1: Method Blank and Spike Results Summary.................................................................. 12
6.2: Duplicate Results Summary.......................................................................................... 13
6.3: Matrix Spike Results Summary..................................................................................... 14
2of14
JCGT942

SGS North America Inc.
Sample Summary
Pilot Travel Centers LLC
Job No: JC67942
ACVAR: #7971, 1343 Rock Barn Road, Conover, NC
Sample Collected -I Matrix Client
Number Date Time By Received Code Type Sample ID
JC67942_l 06/12/18 05:45 HC 06/13/18 AQ Water LOWS 7971
7
$- 3of14
��� JC67942

CASE NARRATIVE / CONFORMANCE SUMMARY
Client: Pilot Travel Centers LLC Job No JC67942
Site: ACVAR. 47971, 1343 Rock Barn Road, Conover, NC Report Date 6/20/2018 12:46:58 P
On 06/13/2018. l Sample(s), 0 Trip Blank(s) and 0 Field Blank(s) were received at SGS North America Inc. at a maximum
corrected temperature of 3.2 C. Samples were intact and chemically preserved, unless noted below, A SGS North America Inc. Job
Number of JC67942 was assigned to the project. Laboratory sample ID, client sample ID 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: GP13805
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC67686-IMS, JC67942-1DUP were used as the QC samples for HEM Oil and Grease.
■ RPD(s) for Duplicate for HEM Oil and Grease are outside control limits for sample GP13805-D1. RPD acceptable due to low
duplicate and sample concentrations.
I Matrix: AQ Batch ID: GP13821
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC67942-1DUP, JC67686-1 MS were used as the QC samples for HEM Petroleum Hydrocarbons.
■ Matrix Spike Recovery(s) for HEM Petroleum Hydrocarbons are outside control limits. Spike recovery indicates possible
matrix interference.
General Chemistry By Method SM2540 D-11
Matrix: AQ Batch ID: GN81396
■ All samples were analyzed within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC68025-IDUP were used as the QC samples for Solids, Total Suspended,
General Chemistry By Method SM4500H+ B-11
Matrix: AQ Batch ID: R170595
■ The data for SM4500H+ B-11 meets quality control requirements.
■ JC67942-1 for p1l: Sample received out of holding time for pH analysis.
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
Wednesday, June 20, 2018 Page 1 of I
4of14
JC67942

Summary of Hits Page 1 of I
Job Number: JC67942
Account: Pilot Travel Centers LLC
Project: ACVAR: #7971, 1343 Rock Barn Road, Conover, NC
Collected: 06/ 12/ 18
Lab Sample ID Client Sample ID Result/
Analyte Qual RL MDL Units Method
JC67942-1 OWS 7971
Solids, Total Suspended 37.3 4.0 mg/I SM2540 D-1 l
C50 pH a _ _ _I su SM4500H+ B-11
(a) Sample received out of holding time for pH analysis.
� 7W
-SG$-
5of14
JC67942

_SGSr
Dayton,
Sample Results
Report of Analysis
Section 4
a
_SGS.. 6 of 14
JC67642

SGS North America Inc.
Report of Analysis
Client Sample ID: OWS 7971
Lab Sample ID: JC67942-1 Date Sampled: 06/12/18
Matrix: AQ - Water Date Received: 06/13/I8
Percent Solids: n/a
Project: ACVAR: #7971, 1343 Rock Barn Road, Conover, NC
General Chemistry
Analyte Result
RL
HEM Oil and Grease 5.3
5.3
HEM Petroleum Hydrocarbons ¢ 5.3
5.3
Solids, Total Suspended
37.3
1'6.50
4.0
pH "
__ 1
(a) Sample received out of holding time for pH analysis.
RL = Reporting Limit
Page 1 of I
Units DF Analyzed By Method
mg/1 1 06/ 15/ 18 17:00 TM EPA 1664A
mg/I 1 06/16/18 17.30 TM EPA 1664A
mg/I 1 06/ 15/ 18 12:00 RC 5M2540 D-1 t
su 1 06/13/18 15:47 SUB SM4500H+ B-11
7of14
JC67942

Dayton, I
Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
Section 5
0
$ of 'i4
-SG9�
JCa7842

CHAIN OF CUSTODY PAGE _ OF
1 ■ 1� .Fi�i
l►1�'i
. +
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.
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■
AW.:6h4)■-01Cati.or■w1af■
JC67942: Chain of Custody
Page I of 2
cn
—SG 9 of 14
JC67942

SGS Sample Receipt Summary
Job Number: JC67942 Client: APEX COMPANIES, LLC
Dale I Time Received: 6/13/2018 9:25:00 AM Delivery Method:
Cooler Temps (Raw Measured)'C: Cooler 1: (3.2);
Cooler Temps (Corrected) 'C: Cooler 1: (3,2);
Cooler Securlty Y
1, Custody Seals Present: ®
or N
❑
Y or N
3. COC Present: ® ❑
2. Custody Seals Intact: ®
❑ 4. Smpl DatoafTlme OK ® ❑
Gpolor Temnerelure
1. Temp criteria achieved:
Y or N
® ❑
2, Cooler temp verigestiom
IR Gun
3, Cooler media:
Ice (Bag)
_
4. No. Coolers:
1
1. Trip Blank present I cooler:
Y or N
❑ SA
WA
❑
2. Trip Blank listed on COC:
❑ Sd
❑
3, Samples preserved properly:
66 []
4. VOCs headepaea free:
❑ ❑
2
Project: ACVAR: #7971. 1343 ROCK BARN ROAD, CON
Airbill Ore.
Samnla Intaorltu Documentation
1. Sample labels present on bottles:
X
®
or N
❑
2. Container labeling complete:
®
© Ch
3. Sample contniner label I COC agree:
®
i
❑
Sample Intearlty - Condi on
1. Sample recvd within HT:
_Y
®
or N
❑
2, All containers accounted for
®
❑
3. Condition of sample:
Intact
Sample lntaarlty-113strucllons
1. Analysis requested Is dear.
-i
®
gr N NIA
❑
2. Bottles received for unspecified testa
❑
3. Sufficient volume rewd for analysis:
®
❑
4, Compositing Instructions clear:
❑
❑
S. Rharing Instructions clear:
❑
❑
Test Strip Lot #a: pH 1-12: 216017 pH 12+: 208717 Other: {Specify)
Comments
SMeae-03
Rev. Date 1217117
JC67942: Chain of Custody
Page 2 of 2
_SG 14 of 14
JC67942

j General -Chemistry
QC Data Summaries
Includes the following where applicable:
• Method Blank and Blank Spike Summaries
• Duplicate Summaries
• Matrix Spike Summaries
Section 6
11 of 14
.._ JC67942

METHOD BLANK AND SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number; J067942
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: V 971, 1343 Rock Barn Road, Conover, NC
MD Spike HSP BSP QC
Analyte Batch ID RL Result Units Amount Result 6Reccv Limits
HEM Oil and Grease
GP13805/GN81450 5.0
HEM Petroleum
Hydrocarbons
GP13821/GNal489 5.0
Solids, Total
Suspended
GN81396 4.0
Associated Samples:
Batch GNS1396:
JC67942-1
Batch GP13805:
JC67942-1
Batch GP13621:
JC67942--1
(-) Outside of
QC limits
0.0 mg/l 40.05 33.0 82.4 78-114%
0.0 mg/l 20.05 12.9 64.3 64-132%
0.0 mg/l
Page 1
(c� 12 of 14
JC67942

i i ,
DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC67942
Account; PILOTSS - Pilot Travel Centers LLC
Project; ACVAR; V 971, 1343 Rock Barn Road, Conover, NC
QC Original DUP QC
Analyte Batch ID Sample Units Result Result RFD Limits
HEM Oil and Grease
GP13805/GNS1450 JC67942-1 mg/l
1.7 0.0 20(6.0{a) 0-18%
HEM Petroleum Hydrocarbons
GP13921/GN81489 JC67942-1 mg/l
1.5 1.5 j0.0 0-34%
Solids, Total Suspended
GN81396 JC68025-1 mg/l
0.60 D.60 O.D_ 0-17%
Associated Samples:
Q�
Batch GN61396: JC67942-1
jy
Batch GP13805: JC67942-1
Batch JC67942-1
(') Outsidetside of QC limits
�
(a) RPD acceptable due to low
duplicate and sample concentrations.
Page 1
-SG$-
43of14
JC67942

MATRIX SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC67942
Account: P[LOTSS - Pilot Travel Centers LLC
Project: ACVAR: #7971, 1343 Rock Barn Road, Conover, NC -
QC original Spike MS QC
Analyte Batch ID Sample Units Result Amount Result 4Rec Limits
HEM Oil and Grease GP13805/GN81450 JC67686-1 mg/1 3.9
HEM Petroleum Hydrocarbons GP13621/GN81489 JC67686-1 mg/1 2.8
Associated Samples:
Hatch GPI3805: JC67942-1
Batch GP13821: JC67942-1
(') outside of QC limits
(N) Matrix Spike Rea. outside of QC limits
(a) Spike recovery indicates possible matrix interference.
Page 1
40.05 38.9 87.4 � 78-114%
20.05 13.8 54.9N(a} : 64-132%
C"
W
14 of 14
a _.�
Jcb7aaz

Energy, Mineral &
Land Resources
ENVIRONMENTAL QUALITY
April 17, 2017
Mr. Alan J. Fass, P.G.
Dynamis, Inc.
F.O. Box 50636
Knoxville, TN 37950
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
RECEIVED
APR 18 Z017
CENTRAL FILES
DWR SECTION
Subject: NPDES Stormwater Permit NCG080428
PFJ Southeast LLC
Formerly Speedway LLC
Catawba County
Dear Mr. Fass:
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained
in the General Permit remain unchanged and in full effect. This revised Certificate of
Coverage is issued under the requirements of North Carolina General Statutes 143-215.1 and
the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land
Resources
cc: Mooresville Regional Office
Mr. Joey Cupp, Pilot Travel Centers, LLC
Stormwater Permitting Program Files
Central Files
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
512 N. Salisbury Street 1 1612 Mail Service Center I Raleigh. North Carolina 27699-1612
919 707 9200

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG080000
CERTIFICATE OF COVERAGE No. NCG080428
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
PFJ Southeast LLC
is hereby authorized to discharge stormwater from a facility located at:
PFJ Southeast LLC
1343 Rock Barn Road
Conover
Catawba County
to receiving waters designated as Lyle Creek, a class WS-IV stream, in the Catawba River Basin;
in accordance with the effluent limitations, monitoring requirements, and other conditions set
forth in Parts I, II, III, and IV of General Permit No. NCG080000 as attached.
This certificate of coverage shall become effective April 17, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 17, 2017.
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

Dynamis, Inc.
mmp�� . ==NO.
P.O. sox 80836, Knoxville, TN 37950
Phone: [phone] Fax: [phone]T
February 10, 2017
Division of Water Quality '
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Transmitted via: Federal Express # 7784 0336 2389
RE: Request Transfer of Permit NCGO80000 for 5 Facilities
Sir or Madam:
RCCEi VED
FEB 14 2017
Sc I. Ar; C)�o�i !T.
Please find enclosed facility participation forms for the following facilities:
Pilot-6955 . �� -
;NCG080455`'°'`CnahaineNC'
Pilot-6978
NCG080716
Candor, NC
r O - r 11
■+\00 B.
9ME , Jc-
Pilot-7976
NCG080170
Troutman, NC
Pilot-7983
NCG080896
Salisbury, NC
This letter is written on behalf of PFJ Southeast LLC and serves as a formal notice of
transfer of ownership from Speedway LLC (successor by merger with Wilco Hess LLC),
to�PFJ,.Southeast-L ';G-rThe deeds are attached for Pilot-6955, Pilot-7971, and 7976. We
are waiting on the deeds for Pilot-6978 and Pilot-7983. These deeds will be transmitted,
upon receipt. Attached are the appropriate forms and/or documentation required to
complete the permit transfer process. If you have any questions or require additional
information, please contact me at 865-588-5422 ext. 208.
Sincerely,
an J. F , P.G.
Environmental Program Manager
Dynamis, Inc.
[e-mail]

Permit Name/Ownership Change Form &
Deed of Transfer of Ownership for
Pilot-7971
Conover, NC
Permit No. NCG080428

Water Resources
£NVIRONNENTAL QUALITY
PAT MCCRORY
U"ver e
DONALD R. VAN DER VAART
S. JAY ZIMMERMAN
Awch'r
PERMIT NAMEIOWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCG0lj� 1-C) /U/-&/K or NCG5 I 1 1 1
1. Facility Name: ') -�> % I t A ':'q"7-f
II. NEW O�ll (NER/NAM,g INFORMATION:
1. This request for a name change is a result of:
_�La. Change in ownership of property/company
b. Name change only
c. Other (please exptain):
2. New owner's name (name to be put on permit):
3. New owner's or signing official's name and title:
(Person legallt respon i e for permit)
_^ t5v, wtoci L
,, (Title)
4. Mailing address: I ,c JV4 Lp aL b1 ik City:(,
State Zip Code: 35 -IPhone:
E-mail
L CAM ,
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements]
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center j Raleigh, NC 27699.1617
919 807 6300 919-807.6389 FAX
https://deq.ne.gov/about/divisions/wa cr-rcsources/vmter-resources-perrnhOwastewwer•branch/npdes-wastewater-permits

NPDES Name & ownership Change
Page 2 of 2
Applicant's Certification:
I,�oe�1 , attest that this application for a
namelowners h ip change has been reviewed and is accurate, and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed and that
if all required supporting information and attachments are not included, this application
package will be returned as incomplete.
Signature: Date:. 7'%I
THE C E1D APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ 1 DWR 1 NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Verslon 712016

ml_w cdow st cam1y
on Nov 14, 2016 at 101"0 am
Exolfie Tarr Maw (MC)
INST. o 19657
h][)NVA MCKS WRCER,
Rtl$leler of 0"M
m 03371 P91057-1062
NORTH CAROLINA
CATAWBA COUNTY
Tax Lot No. 3752 L 3042584.........................4.........I.............. Parcel Identifier No .....................................................
Verifiedby.................................................................. County on the ......................day of .................................. , 20.............
by ........................................................... ........ ..... .................... ......... ...... ......... ............. ............ .................. I .............. I ..........
....
Mail after recording to -First t merican Title Insurance Company, Attn: Hilda Berbosa, 30 North LaSalle Street, Suite 2700,
Chicago, IL 60602... �....................................... ............................................................................................................... ..............
....................................................................................................
This instrument was prepared by: Kevin C. Lewis, Attomey-at-Law, 500 Speedway Drive, Enon, OH 45323
Briefdescription for the Index 375213042584
Excise Tax: $3,848.00
NORTH CAROLINA SPECIAL WARRANTY DEED
THIS DEED made effective this 6th day of November, 2016, by and bctwcen
GRANTOR
SPEEDWAY LLC (successor by merger with
W ilc 3Hess LLC)
a Delaware limited liability company
500 Speedway Drive
Enon, OH 45323
GRANTEE
PFJ SOUTHEAST LLC
a Delaware limited Hability company
whose tax maiiing address will be
c/o Intax, Inc.
F.O. Box 54650
Lexington, KY 40555
Enter in apFr Iau block for oath PW, nos, WM9. and, If nppmprlate. charmer orenNty, a.q. corporation or parumbip.
The designation Grantor and Grantee as used heroin shall include said parties, their heirs, successors, and assigns, and shall include singular,
plural, masculine, feminine or neater as required by context.
W ITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt ofwhich is hereby acknowledged, has and by
these presents does grant, barpin, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land, together with all
buildings and other improvements situated in the City Of Conover, Catawba County, North Carolina and more particularly described as
follows:
See Exhibit "A" attached hereto and made a part thereof.
Said property having been previously conveyed to Grantor by instruments) recorded in Book 2282, P age 1788 and Hook 2282,Pap 1765
at Catawba County, North Carolina.
Unit 0:7971
Addren: 1343 Rod Dam Rd.
Conover, NC
I of 3
%a

All or a portion of the property herein conveyed _ includes or X does not include the primary residence of a Grantor.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in fee
simple.
And the Grantor covenants with the Grantee, that GrunIOr has done nothing to impair such title as Grantor received, and Grantor will
warrant and defend the title against the lawful claims of all persons claiming by, under or through Grantor, except for the Permitted
Exceptions as defined in that certain Contribution, Assignment and Assumption Agreement dated June 17, 2016, by and between Speedway
LLC, Pilot Travel Centers LLC and PFJ Southeast LLC.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seat, or if corporate, has caused this Instrument to be signed in its
corporate name by its duly authorized officers, this _tt day of November, . 2016.
SPEEDWAY LLC
as successoi by merger with WilcoHess LLC RAI
By: .
Printed: Gregory S. Q-..h ....................
Title: Director, Real Estate and Operations Planning ......................
SEAL -STAMP
State of Ohio, Clark County.
1, the undersigned Notary Public of the County of &!�rA and State aforesaid, certify that Grc&flJv S. Whitman of 5R dwaV
LLC. nersonally appeared before me this day and acknowledged the due execution of the foregoing instnunent for the purposes therein
expressed. Witness my hand and Notarial stamp or seal this 'I* day of November, 2016.
My Commission Expires;3 Notary Public
(Affix Seal) Notary's Printed or yped game
KATHER><NE S. BORGWAILD
NOTARY PUt' UC 4 STATE OF OHO
lYty oommisalon oltpirea $I1ti1t8
Unit 0:7971
Addrar. 1343 Rock 04m Rd.
Conam, NC
2ofI

EXHIBIT A
Speedway 7971
1343 Rock Barn Rd.
Conover, NC
Tract One — (5.21 acres)
BEING all of that certain 5.21 acre tract as shown on survey by Sam Rowe, Jr. dated October 31, 1994, entitled "Minor
Subdivision, Clarence E. Roseman, Jr. & Horace J. Eisenhower Jr. Pro., Clines Tshp„ Catawba County, N. C." and of
record in Plat Book 36 at page 106, Catawba County Registry, and reference to said record is hereby made for a more
complete and detailed description.
AND BEING the same property conveyed to Grantor from A. T. Williams Oil Company, Inc, by deed doted June 8,
2001, recorded in Book 2282, page 1795, Catawba County Registry.
Prior deed reference: Book 2282 Page 1785
Tract Two (1,05 acres)
BEGINNING at an iron pin located at the Southwest comer of the 5.21 acre -tract owned by A.T. Williams Oil Co.,
which said iron pin is located North 37" 58' 40" East a total of 450.48 feet from a control comer located at the
Northeast corner of A. T. Williams Oil Co.; and running thence with the line of A.T. Williams Oil Co. North 370
58' 19" West 602.54 to an iron pin; thence continuing North 370 58' 19" West 57.26 feet to an iron pin, anew
comer of Clarence R. Roseman, Jr. and Horace J. Isenhower, Jr.; and running thence with the line Clarence R.
Roseman, Jr. and Horace J. Isenhower, Jr., South 80 08' West 103.55 feet a new iron pin, another new corner of
Clarence R. Roseman, Jr, and Horace J. Isenhower, Jr.; and running another new line of Clarence R, Roseman, Jr.
and Horace J. Isenhower, Jr., South 37' 58' 19" Past 79.4 to a new iron pin; thence continuing South 37° 58' 19"
Fast 500.83 feet to an iron pin in the Western edge ofright of way of Rock Barn Road; thence running with the
Western edge of right of way of Rack Barn Road, North 37° 58' 40" East 75.0 feel to the point of Beginning,
containing 1.05 acres, more or less, according to a survey and plat thereof prepared by Sam Rowe, Jr. Registered
Surveyor, on March 11, 1995.
AND BEING the same property conveyed to Grantor from A. T. Williams Oil Company, Inc, by deed dated June
8, 2001, recorded in Book 2282, page 1788, Catawba County Registry.
Prior deed reference: Book 2282 Page 1798
Tax Parcel No.: 375213042584 (Tract One & Two)
THIS INSTIRUMENT FILED FOR RECOgo BY FIRSTAIRERICAN
TITLE INSURANCE C4, AS AN ACGt9DDATION ONLY.
IT HAS NOT BEEN EXAMINE13 U TO n3 EXECUTION
OR AS TO ITS EFFECT UPON TITLE,
Unil N:7971
Addron: 1343 Rock Barn Rd.
Conover, NC
3 of 3

41 10
Delaware
Page 1
The First State
I, JEFFMY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY THE ATTACHED IS A TRUE AND CORRECT
COPY OF THE CERTIFICATE OF MRGER, WHICH MERGES:
"1VXLCO FOOD SERVICES LLC", A DELALIMITED LIABILITY
COMPANY,
"HESS WILCO HOLDINGS, LLC", A DELAWARE LIMITED LIABILITY
CC7fb "Y,
"WILCOHESS ZLC', A DELAWARE LIMITED LIABILITY COMPANY,
"HESS RETAIL HOLDINGS LLC", A DELAWARE LIMITED LIABILITY
COMPANY,
WITH AND INTO "SPEEDWAY LLC" UNDER THE NAbm OF "SPEEDWAY
LLC°', A LIMITED LIABILITY COMPANY ORGANISED AND EXISTING MWER
THE LAWS OF THE STATE OF DELAWARE, AS RECEZVED AND FILED ZN THIS
OFFICE ON THE TWENTY—SECOND DAY OF DECER, A.D. 2015, AT 1:47
O'CLOCK P.M.
r
AND I DO HEREBY FDRTHER CERTIFY THAT THE EFFECTZVF DATE OF
THE AFORESAID CERTIFICATE OF MERGER IS THE FIRST DAY OF JANUARY,
A.D. 2016 AT 12:01 O'CLOCK A.H.
2775076 8100M 'tl
SR# 20151490339
You may verify this certificate online at corp.delaware gov/authver.shtmi
Authenticatl on: 201603793
Date: 01-04-16
r
1:1

Delaware Page ,�
The First State
2775076 8100M
SR# 20151490339
You may verify this certificate online at corp.delaware.gov/authver.shtml
LAI
Authentication: 201603793
Date: 01-04-16

. . d
state of D&Wan
Swiftly of stat
DkWu of Cor"Mdoill
Ddhwd 01,47N412122015
FILED 01.47Phi IMMOIS
SR 201514963D - Wumber 1775076 State qf'D-pj#tWAry
C-
'00cgte.:of Morgoirof pip
1poine9d; Umfted Usbifity C, grqp ,gpfes
Pursuant,to-31de 6,,.-ScWon48209.-of the-DelavmmlAmited-Ugbift..ConVAny.-Ac% flwwWevdgwd
First: 7be name of the surylivmS. Limited Liability Company is Speedway LW
and'the amnos 0-the"wd liefiffity-vompam'es W -,mer gad
M ty
cqmpan
W -am Wil;pHess 16o "s LLq..0.110-Oploirnp . _ W , L
Second: The.Agreemeta.aWerger has been -a tcd,-cqrtifi4 cNocut and
aclalowladged�reaGil
Thirdr 11w ni!me-of;thc PUVi*g.kitYkitedj(*lkty,coM -U1$pvOW -LLC.
pp , y
Fourth: Tile rnew.-is:to-become.offective.*nJanupzy 1..2016-412:01.xm.
Ffflb:."The Agreement of Merger is on Iile-.ut. SOO.Spoedwa
W Drive, Enon, Ohio 4532.3-105.61 the
PrMelpal,plom oftuaness of swAving,Umited t-fdrility Company.
Sixth:,A,cqPY- of.the Agreement .oft WMvW 1imikd
1Wlify"4*y-o#-xt44e.', -.v idtoiktco—A 4
COTWWPS.
IN WI.TNE$S WHEREOF, said surviving UndW liability compmyhas..cqtqvd ads- certificate
to be
I Pled, an au#iwrizeQpawn.Ae
PY.", V&...
Name: Shane T.Pflaidaw.
Title: AssistantAcaretuy
P8023a"')
RKrN

Title Chain and Deeds of Transfer of Ownership for
Pilot-7971
Conover, NC
Permit No. NCG080428

7971 (1.05 acres) 5 `� `� (� .N 0— J
1343 Rock Barn Rd. BooK 2 2 8 2 PAGE 1 OC7
rl i� p
NO REVENUE Conover, NC V FILP) ! '
F U11 !,V,,CKIE
4193V 20111 JUN 27 HM 1017
�. REG€ST?:ft 'F DEEDS
Prepared by and Mail to: David W. Bailey, Jr., Bailey Bt Thomas, P.014TQ4'rBA Go., 1!.C.
P. 0. Box 52, Winston-Salem, NC 27102
Mail tax bill to: WilcoHess LLC, 5446 University Parkway, Winston-Salem, NC 27105
Excise Tax $-0- (Consolidation) N.C.G.S. 105 228.29(7)
NORTH CAROLINA
GENERAL WARRANTY DEED
CATAWBA COUNTY
THIS DEED made this,��day of , 2WI, by and between
A.T. WiLLIAM9 OIL COMPANY, iNC., a Oft Carolina corporation with its principal office in
^ Forsyth County, North Carolina, hereinafter referred to as "Grantor"; and W0coE1ess LLC,
a Delaware limited Iiability company, liereirofter referred to as "Grantee";
WITNESSETH:
That the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is
hereby acknowledged: has and by these presents does grant, bargain, transfer and convey unto the
Grantee in foe simple, all that certain lot or parcel of land situated in Catawba County, North
Carolina, and, more `particulady described as follows:
SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF,
Said. property is be'urg transferred and conveyed as a contribution to capital. as part of
the formation of a new limited liabiltty company,
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and
appurtenances theretobelonging' to the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee
simple, has theylght to convey the same infee simple; that title is madmubWarid free and clear of
all encumbrances, and that Grantor will warrant and defend the,title against the lawful claims of all
persons whomsoever except for the exceptions hereinafter stated: Easements and restrictions of
record.
IN WITNESS WHEREOF, the Grantor has hereunto set their hand and seal the day and year
A.T. OIL COMPANY, INC.
By. -
Stephen T. Williams, President
[CORPORATE SEAL]

BOOK 2282pnE1789
STATE OF NORTH CAROUNA -- COUNTY OF
a Notary Public of the County and State aforesaid, certify that
Roger S. FWp personal y came before me this day and acimowledged that he is Secretary of A.T.
WUJIAME OIL COMPANY, INC.. a North Carolina corporation, and that by authority duly given
and as the act of the corporation, the foregoing instrument was signed in its name by its President,
sealed with its corporate seal and attested by him as its Secretary.
Witness my hand and official stamp or seal, this =—day of , 2001.
My Commission Expires: Gi0 J -
L#AftDA4
ttvraavrua oimso+uiotnn
Mprean�+eWoa y�,mo�
The foregoing certificate(s) of
is/are cwtiPied to be coma. This instrument and this certificate am duly registered at the date and
time and in the Book aW Page shown on the first page hereof.
By:
REGISTER OF DEEDS Deputy/Assistant-Register of Deeds
COUNTY

HIBIT "A" 80ox 2 2 8 2 PAGE 1 l 9 O
BEGINNING at an iron pin located at the Southwest corner of the 5.21
acre -tract owned by A.T. Williams Oil Co., which said iron pin is
located North 370 58' 404 East a total of 480.48 feet.from a control
" corner located at the. Northeast corner of A. T. Williams Oil Co.; and
running thence with the line of A.T. Williams oil Co. North 370 58' 190
West 602.54 to an iron pin; thence continuing North 370 58' i9" West
57.16 feet to an iron pin, a new corner of Clarence R. Roseman, Jr. and
Horace J. Isenhower, Jr.; and running thence with the line Clarence R.
Roseman, Jr. and Horace J. Ieenhower, Jr., south 8° 08' West 103.55
feet a new iron pin, another new corner of Clarence R. Roseman, Jr. and
Horace J. Isenhower, Jr.; and running another new line of Clarence R.
Roseman, Jr, and Horace J. Isenhower, Jr., South 370 581 19"'Raet 79.4
to a new iron pin; thence continuing south 370 88' 19" East 500.83 feet
to an iron pin in the Western edge of right of way of Rock Barn Road;
thence running with the Western edge of right of way of Rock Barn Road,
North 37° 58' 400 East 75.0 feet to the point of Beginning; containing
1.05 acres, more or leas, according to a survey and plat thereof
prepared by Sam Rowe, Jr. Registered Surveyor, oii March 11, 1995.
AND BEING the same property conveyed to Grantor from Horace J.
Isenhower by deed dated 3-22-95, recorded in Book 1922, page 1495,
Catawba County Registry.
41.
STATE OF NORTH CAROLINA
CATAWBA COUNTY
The foregoing certificate of E. Marie Davis a Notary
Public of Forsyth County, NC is
certified to be correct. Filed for registration this
27th day of June 2001 at 10:17 A.M., and duly
reco� rife in the office of the Register of
deeds for Catawba County, NC
in Book 2282 at Page 1788
This 27TF- day of June, 2ti6�.
,� r Ruth Mackie Register of eeds Ps

7971 (5.21 acres) [iODI( 2 2 8 2 rA6E .17 8 5
No REVENUE 1343 Rock Barn Rd.
Conover, NC i.'Url,
1014 JUN 'l7 f�17/I 101 G
Prepared by and Mall to: David W, Bailey, Jr.. Bailey A T"ri'w-" La, NIX,
P. O. Box 32, Winston-Salem. NC 27t02
Mail tax bill to; WilcoHess LLC, SM6 University Parkway, Winston' -Salem, NC 27105
Excise Tax S-0- (Consolidatian) N.C.G.S. 105-229.M7)
01931f,
NORTH CAROLINA
GENERAL WAR. ANTY DEED
CATAWBA COUNTY
THIS DEED made tale ��dey of , 2001; by'md betumen
A.T. WhijAM$,OiL COMPANY; INQ. a rth Caiolina,coMaration % huh,iis princippt ornmlin
Forsyth County, Norio Carolina. hembl after.lt inn' W as. "Gttutwr"c and Wikokesk LLC,
a Delaware. limited. liability.comireor , hereinafter referieilimfis "diathee"; 5446' Uni.vers i ty
Parkway, ytnttofi Safem, Yt: 27115
G7-1
'That the Grantor, for a valuable c` literati �patW*1'tficiGrantee.,the receipt of which is
herebyacknowkd gall has and by these.pre�oea gr� bargain. uar:sfer and convey iusto the
Qtantee in fee airnlple, all that certain�ilil or�Pareet oiland.aitwted is Catawtla County, IYorrit
Caiolina, and more particularly dcFeribee9 " roilo
V
SEE EXII1BlT 'A�► A F.DRETO AND MApE A PART HERFAF.
Said,Property is being trarisfe'rrod, d conveyed, as a contribution to .capital as part of
the fort�ttion bf a new limited iiatsilily company.
TO IIAVE AND TO HOLD the aforesaid lot or parcel of land 'and all privileges and
appurtenances thereto Belonging to the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor :is; seized of the premises in lee
simple, has. the ,right to convey -the some in fee simple, that title is.mittkelable and free and clear or
all encumhrance�i, and That Grantor will *60ant artd Jeftnii the title agairtst`the lawful claims of all
persiihs whnmsoever except for the ckt vptuins hereinafter stated, Easements and restrictions of
ncard.
IN WITNESS, W11FRII-OF. the Grantor has herrunrn set their hand and seal the day and year
fiat ahnv:c written.
fLvv- it 4 4
A.T=Williams.
C.

UOL-K. .2 2 3 2 WE 17 8 6
STATE OF NORTH CAROLJHA -- COUNTY OF
a Notary PqW10 of Oki county MW Suft aforesaid, 041ty that
Roger S.FMp pgroonally came before assthis day andackrm*iW&d that ht li,Secrc%M of A.T.
WIWAMS,OIL'COMPANY. INC., a North �Carolltm coqK=tknN ud'*u by Wut>< ky, duly, given
acid as the act of the cuqxxuiort,'*m f6:v&oln8'*tiv W'U' iWW'W Us earn by hi prelwcw,
scald with Its corporiie iiilirid Algitied by" him is b Secretary.
Witness my hand and official amp or seal. this Ail" Of 12001.
My cofl�mlsslou Expires:OZ4.
z 14 Nourvlk�61, �
The fingobe ca"IfWatc(s) of
is/are certified to be Ccrr . ;Mds,lnvxwr*M-aPd this ".4uly-regiond at the date &TA
tk6 mWin the Book and Page shown on ihchrii papa ilt6i o .
COUNTY.

ooa 2.282PAoEI787
EXHi BIT "A"
BEING all of that cartain 5.21 acre tract as shown on aurvey by gam
Rowe, Jr. dated October 31, 1094, entitled "Elinor Subdivision. Clarence
E. Roseman, Jr. a Horace J. isenhower Jr. Pro., Clines Tehp., Catawba
County; N.C." and of record in Plat; Book.36 at page 10B, Cata%pba County
Registry, and reference to said record ia'liereby made tar a more
complete and detailed deacription.
AND BEING the same property conveyed to Grantor tram Horace J.
Isenhaiier by deed dated 11-23-94, recorded In Book 1910, page 687,
Catawba County Registry.
40.
##A#fff#A####RffAAf#Af i#ifA
STATE OF NORTH CAROLINA
CATAM COUNTY
the foregoing Certificate of E. Marie. is a ary
Public of Forsyth County, North C ' lira s
certified to be correct; Filed tor. gistra
27th day of J06 20D1 it .1b; A^, 61y
recorded n the offf�;"of the e" to -df
Deeds for Catawba Couniy, NC
in Book; 2282 at Page 1785
This 271Ti day "or To-
Jl
Mackie eg s er . ed . -*✓ PS

Delaw-a'
a Page 1
Thefirst State
I, JEFFREY W. BULLOQt, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO RERERY CERTIFY THE ATTACHED IS A TRUE. AND CORRECT
COPY OF THE CERTIFICATE OF MRGER, WHICS NERMS:
"WILCO FWD SERVICES LLC", A DEZJLPG a LIMITED LIABZJ,ITY
"MESS WILCO H=Z=g, LLC", A DZZMG RE UNITED.LIABILITY
COWAN r,
"WILCONESS LLC", A DELAWARE UNITED LIABILITY• CCWANY,
"HESS RETAIL HOLDINGS LLC", A DELANARE LIMITED LIABILITY
CCNPANY,
WITH AND i1UT0 "SPEEDF ar LLC" mum THE mAw OP' "SPEEDWAY
Y,ZCff, A L=TED LIABILITY CCMANY ORGANIZRD AND EXISTING UNDER
THE LAWS OF THE STATE OF DELAWARE, AS 'RECEIVED'"Al= 7ZZED. TIC 'THIS
OFFICE ON THE TNENTY-BEConD DAY OF DECMM, ' A•: D.- 2015, : AT":1:.4 7
O'CLOCK P.N.
AND I DO M3=Y FURTHER CERTIFY THAT THE EFFECTIVE:"DATE OF
THE AFORESAID CERTIFICATE OF URGER IS THE FIRST DAY OF .Tmmr, .
A.D. 2016 AT 12:01 O'CLOCK A.N.
�4
2775076 8100M Authentication:201603793
SR# 20151490339 : ' " , �te: 01-04-16 i7
You may verity this certificate online at corp.deiaware.gov/authver.shtmi

2775076 8100M
SR# 20151490339
You may verify this certificate online at corp.deiaware.goy/authver.shtmi
Authentication: 201603793
Date: 01.04-16

Stitt 0"1 DAawan
trf 41 slit!
Dhislou 01 corponfl0Il!
DdireW 01:47 PM 12nin015 _ — -- • — _ .. :.r..�
IUD &:47 PM 1212212013
SR` 20151490339 - FYle.Number 2775076 Q D,ea�yar
r�ca.#�e .ofi:Aegr �uf
Demes0g, LWW— Llabuity C.ompsoles
PMt=tto:Titic 6,'sewon:18 Z09.Ofthe Delwn=1 w[ftd i iabili9y,.:t,:ompaexq'Act,. a iindelsigoied
iirM'tt AiWAuty company cxeru�$t Iowit #e of der:•
Firsts The name of the surviving Limited �.iabiiit7i PeoY $i "Y"
aia the nmesm.eb.00ibwm d ito;Q'.6'A;V" ng iw'li ey� .
WOPoo' Li '
iVaRiil LSOIt;tt1S IrLCir fit~ :� �i1�: T#t�d£e�f: L,L�.
mod: �:Agreement,viMergcr.fia��beez;�gpaov0d,.�de�pbal, oertliu�:ea�ectu�d.sud
adcnowledged`:lryea���4�•co�6ti't>��1�•.li�iii�r.'companles. '
Tltwr..Tlip'ORna•af:ttuc survi?viug.lzted Git!'cmpnY.=is 9>eedvYayLL:
Yourth: 'lam �nccger is to became;e�gadve nn lanu�y I,.ZQI� at 'l�.�i,�.m.
i�Ylt U: 'i & Agreement of Ma2W is onBe Beat SW::Spccdww 1 rxl Ilt>n�, .C)Ixio 45323-14�6, the
Pindpalplace.vfbasiness:oft#ie,arWving=Limbed LfaWky,do4any,
Sixtlbr ;A; �oapyo:the Ao�nent•o€1Il.be:iiumd.:by t.I'i3nite�l
liaitTilfity,•eortya��queat�vvttls�a�lt;Est;,.to;,a6p.:member:ai��e:oansti;li,�fite�;Ii�ility..
WlTi 89 ' ERWY, said §u.Mv'iog. iWOOd "lity cpi0psny'hss..ciuqW tho.cedifiqate
to�be•:�g•�r;a>�'a��.pr�tl�:'tip'de�a�b�,t�C�er,,�3�„��41;•,�., . ,
Na�we. Shne.r Nleidew..
.. • �'itie:ista�i�Secretary' .
(3860T1:RTF..}

la r De ova e
Page 1
The First State
I, JEFFREY W. BULLOM, SECRETARY OF STATE OF TIE STATE OF
DELAWARE, DO HERNBY CERTIFY THE ATTACBED IS A TRUE AND CORRECT
COPY OF THE CERTIFIC.'ATL OF MRGER, WBICB MERGES:
"TfZZCO FOOD SERVICWS LLC", A DNLAWARE LIMITED LIABILITY
COMPANY,
"MESS AIIZC:O BOLDINGS, LLC", A DELAWARE LIMITED LIABILITY
COMPANY,
-WZZCORXSS LLC", A DELAWARE LIMITED LIABILITY COMPANY,
"MESS RETAIL BOLDINGS LLC", A DELAWARE LIMITED LZABILITY
COMPANY,
WITB AND INTO "SPEEDI4AY LLC" U=ZR TBE NAME OF "SPEEDWAY
LLC", A LIMITED LIABILITY CLMPANY ORGANISED AND EXISTING UNDER
THE LAWS OF THE STATE OF DELAWARE, AS RECEZVED AND FILED IN THIS
OFFICE ON ME TIVENTY-SECOND DAY OF DECOMM, A.D. 2013, AT I:47
O'CLOCK P.M.
AND I DO FDL'RWBY FURTHER ceRTIFYrTBAT Tm EFFECTIVE va= OF
THE AFORESAID CERTIFICATE OF M ItGER IS THE FIRST DAY OF JANUARY,
A.D. 2016 AT 12:01 O'CLOCK A.H.
2775076 8100M "�J
SR# 20151490339
You may verify this certificate online at corp.deiaware.gov/authver.shtml
Authentication: 201603793
Date-. 01-04-16
r
!:1

Delaware Page 1061
The First State
2775076 8100M
SR# 201514130339
You may verify this certificate online at corp.deiaware,goy/authver.shtml
Authentication: 201603793
Date: 01-04-16

314te of ftworl
Staftly of Swe
Dkmu of cor"ndni
DdWaid 01.477MI3112/2015
FLED 01-47PHIMMOIS
SR IOISIO0339 - RkNumbir 1715076 S*te 9f 'Deloware
COVARCOP—Of Merger 0
Dome Or LlmktO Uibility C,91qp %pies
Pummwo.Ulc 6,,-Secdon;18-209..ofthe-Delaware Umiud.lAabihW.�-Comp.any.-Ac.l4.ft undwWgnqd
fimite0awlity coiopanyexewwthe: fimowinsomacato amerier.
First: The nwne of the surypiiing. Limited Liability Company Is Spee4wqy L-.W.,
and'the amm of ft limiter!WbI14Y.Compamies 1.4nerge4 im ty .
.pmpan 3.1oplims UMV116o AnO M*.
.yam W Ur,
Secoq4--71w.Awccment.*F-Ma&cr fins beenV prowdWept4mqd fie eXec . and
ck W4
Third -.:'The nwm.ofAe surviVmg.Vimited liability,qMp g"yjS44peWWay-LLC-.
Fourth: The mewisio become.efibctiveonlanuaty. 1,201.0-at 12:01.xm.
rddr.. ne Agreement of Merger Is on filest- SOO.Speedway DdVC6 Enon, -Ohio 453234056, the
principal place Orbusinessofthe mumviog-UmItpa tforility dompmY.
Sixth.-Apopy of.the AgrecumdotMew•willbe fwnished.by6c4,Wmvm'6 1-m-u-ted
00fil
compact PS.
IN. WITWAS W=RWY, said surviving Onfitecl liability cowp c
copy ped, this. cpdfiqg
zqu
to be Pignid* ad-4041b"*p MON.
w
9-4000. ,
Name: Shane T. Pilcidem.
Title-. AssistantSecmiary

FILED C8igftB COWI(y
on Nov 14, 2016 8t 10:10:00 lam
EMSe Tait M (MC)
MURA MCKSWI31MR,
weber el onaa
m 03371 P9 1057-1062
NORTH CAROLINA
CATAWBA COUNTY
Tax Lot No. 3752I3042584................................................. Parcel Identifier No .....................................................
Verifiedby............................................................... County on the ...................... day of ................................. , 20.............
by..............................................................................................................................................................................................
d Mail after recording to First American Title Insurance Company, Attn: Hilda Barbosa, 30 North LaSalle Street, Suite 2700,
Chicago, IL 60602..... 5"4„ ......................................................................................................................................................
. ....get 'rtrat................................. ........................................................................................................................
This instrument was prepared by: -Kevin C. Lewis, Attorney -at -Law, 500 Speedway Drive, Enon, OH 45323
Brief description for the Index 375213042584
Excise Tax: $3,948.00
NORTH CAROLINA SPECIAL WARRANTY DEED
THIS DEED made efFective this 6th day of November, 2016, by and between
GRANTOR GRANTEE
SPEEDWAY LLC (successor by merger with
WilcoHess LLC)
a Delaware limited liability company
500 Speedway Drive
Enon, OH 45323
PFI SOUTHEAST LLC
a Delaware limited liability company
whose tax mailing address will be
c/o Intax, Inc.
P.O. Box 54650
Lexington, KY 40555
Enta Ina puphft block for =cb arty; none, Wren, and. if epwapri+te. Chesser of 0tW s.q. eofporatinn a r+erarerahip.
The designation Grantor and Grantee as used heroin shall include said parties, their heirs, successors, and assigns, and ahall include singular,
plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt ofwhich is hereby acknowledged, has and by
these presents does grant, bargain, sell ad convey unto the Grantee in fee simple, all that certain lot or parcel of land, together with all
buildings and other improvements. situated in the City Of Conover, Catawba County, Nash Carolina and more particularly described as
follows:
See Exhibit "A" attached hereto and made a part thereof
Said property having been previously conveyed to Grantor by instrument(s) recorded in Book 2282, Page 1788 and Book 2282, Page 1785
at Catawba County, North Carolina.
Unit km t
Addnm: 1343 Rock Barn Rd.
Comver. NC
1 of 3
b

All or a portion of the property herein conveyed _ includes or X does not include the primary residence of a Grantor.
TO HAVE AND TO HOLD the aforesaid tot or parcel of land and all privi leges and appurtenances thereto belonging to the Grantee in fee
simple,
And the Grantor covenants with the Grantee, that Grantor has done nothing to impair such title as Grantor received, and Grantor will
warrant and defend the title against the lawful claims of all persons claiming by, under or through Grantor, except for the Permitted
Exceptions as defined in that certain Contribution, Assignment and Assumption Agreement dated June 17, 2016, by and between Speedway
LLC, Pilot Travel Centers LLC and PFJ Southeast LLC.
IN WI TNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this instrument to be signed in its
corporate name by its duly authorized officers, this 91-4*' day of 2016.
SPEEDWAY LLC
as successor by merger with WilcoHess LLC RAI
ey:. ......................................
Printed: SWhitmn...................... Title: Director, item Estate and Operations Punning ......................
SEAL -STAMP
State of Ohio, Clara County.
1, the undersigned Notary Public of the County ofCJOA and State aforaaid, certify that Grcgga S. Whitman of S
Impersonally appeared before me this day and acknowledged the due execution of the foregoing instrument for the purposes therein
expressed. Witness my hand and Notarial stamp or seal this 1111t*- day of November, 2016.
My Commission Expirosl �"�`� Notary Public
(Affix Seal) Notary's Printed or yped game
KATHMM S. BORGWALD
NOTARY PUBLIC a STATE OF OHIO
MY oarrurllaefotn �tplroa gi1$f18
Unu 0:7971
Addrus: 1343 Rock Ova Rd.
Conover, NC
2of3

EXHIBIT A
Speedway 7971
1343 Rock Barn Rd.
Conover, NC
Tract One — (5,21 acres)
!.:
BEING all of that certain 5.21 acm tract as shown on survey by Sam Rowe, Jr, dated October 31, 1994, entitled "Minor
Subdivision, Clarence E. Roseman, Jr. 8c Horace J. Eisenhower Jr. Pro,, Clines Tshp., Catawba County, N. C." and of
record in Plat Book 36 at page 106, Catawba County Registry, and reference to said record is hereby made for a more
complete and detailed description.
AND BEING the same property conveyed to Grantor from A. T. Williams Oil Company, Inc. by deed dated June 8,
2001, recorded in Book 2282, page 1785, Catawba County Registry.
Prior deed reference: Book 2282 Page 1785
Tract Two (1.05 acres)
BEGINNING at an iron pin located at the Southwest comer of the 5.21 acre -tract owned by A.T. Williams Oil Co.,
which said iron pin is located North 37" 58' 40" East a total of 450.48 feet from a control comer located at the
Northeast comer of A. T. Williams Oil Co.; and running thence with the line of A.T. Williams Oil Co. North 370
58' 19" West 602.54 to an iron pin; thence continuing North 370 59' 19" West 57.26 feet to an iron pin, a new
comer of Clarence R. Roseman, Jr. and Horace J. Isenhower, Jr.; and running thence with the line Clarence R.
Roseman, Jr. and Horace J. Isenhower, Jr., South 80 08' West 103.55 feet a new iron pin, another new corner of
Clarence R. Roseman, Jr. and Horace J. Isenhower, Jr.; and running another new line of Clarence R. Roseman, Jr.
and Horace J. lsenhOWer, Jr., South 37° 58' 19" East 79.4 to a new iron pin; thence continuing South 37° 58' 19"
East 500.83 feet to an iron pin in the Western edge of right of way of Rock Bam Road; thence running with the
Western edge of right of way of Rack Barn Road, North 37" 58' 40" East 75.0 feet to the point of Beginning,
containing 1.03 acres, more or less, according to a survey and plat thereof prepared by Sam Rowe, Jr. Registered
Surveyor, on March 11, 1995.
AND BEING the same property conveyed to Grantor from A. T. Williams Oil Company, Inc. by deed dated June
8, 2001, recorded in Book 2282, page 1788, Catawba County Registry.
Prior deed reference: Book 2282 Page 1788
Tax Parcel No.: 375213042584 (Tract One & Two)
THIS INSTRUMENT FILED FOn RECORo BYFIRSTANERICAN
TITLE INSURANCE CO. AS AN ACCOMI.IODATION ONLY.
ITHAS NOT BEEN EXAMINED 13 TO ITS EXECUTION
ORAS TO ITS EFFECT UPON TITLE.
Unil Vgr71
Addrm: 1343 Rock Bun Rd.
Conover, NC
3 of 3

Semi-annual Stormw_ater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted 12/2/15 100J010
CERTIFICATE OF COVERAGE NO. NCGO80428
FACILITY NAME WilcoHess Travel Plaza # 351
COUNTY Catawba
PERSON COLLECTING SAMPLES Lynne Hays
LABORATORY R&A Lab Cert #34 Comments on sample collection iRECEIVED
analysis: DEC 0 7 'LM
CENTRAL. FILES
Part A: Vehicle Maintenance Areas Monitoring Requirements DWR SECTION
SAMPLE COLLECTION YEAR _2015
SAMPLE PERIOD Jan -June X July -Dec
or Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW [I]Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period'
Qutfall.;
_ No. -
r. ,..
-
Date
-,Sample Collected,
rrme/dd/yr
--` 00530
00400 : -u°
00555 .
- Total Suspended;
Solid s, m /1.,
.g
pH,' `'
Standard units'
`Non =Polar OiI and Gres§e/TPH EPA
_ Method 1'fi64 SGT HEM m L _
x. €New-Motor<:Ojl Usage;
_
Annual a�era
Benchmarkpermit
Within6 0 90
15
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 B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
=.Out€all
No :'.
Date
Sample Collected,
mo/dd/yr"�'1664.(SGT`:HEM),
00556
005.30;x00400a
-;
` Non-Polar�0il and Grease/TOk ERA Method:
mg/L
Total Suspended Solids,
mg/L
5t_andard,urnts;
Pei•'mit Limit
.' .; _ _ ....
Y 4 ; 45 V .
p or, 100 see, permit
6 0 9x0
SDO #1
11/7/15
<5
188
7.3
SDO #2
11/7/15
No flow
No flow
No flow
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 October 25. 2012
Page I of 2

STORM EVI,NT CHARACTERISTICS:
-00
Date 11/7/15 (first event sampled)
Total Event Precipitation (inches):.14
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 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 it SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO x
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy gf this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Lynne Hays or AT Williams Oil Company 1212/15
{Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: http,//portal.ncdenr.org/web/wq/wsLsulnpdessw#tab 4
S W U-250
last revised October 25, 2012
Page2of2

Semi-annual Stormwater Discharge Monitoring Report
r for North Carolina Division of Water Quality General Permit No. NCGO80000f
Date submitted 4/17/15 4F
CERTIFICATE OF COVERAGE NO. NCG080428`1 RECEIVED
FACILITY NAME WilcoHess Travel Plaza # 351
COUNTY Catawba APR 2 2015
PERSON COLLECTING SAMPLES Lynne Hays
LABORATORY R&A Lab Cert #34 Comments on sample collecti VNR
TRAL FILES
analysis: SECTION
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR _2015 p
SAMPLE PERIOD xJan-June July -Dec
or Monthly' month
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
❑Zero -flow ❑Water Supply [_]SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/�yr
o0530
Total SuspendedWli
Solids, mg/L
00_4{}0
pH,'=.
ndard units
00556
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT�-HEM), mg/L
New Motor Oil Usage,
Annua! averag�gal/mo
Benc TnTark
-
50 or 100 see permit
Within
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? x yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall=Sam
No.
De
Collected,
/dd/.yr
0055fi"`
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT�HEM), mg_�L
Da53D
Total Suspended Solids, ,
mg/L
Oa400
pH,
Standard units
Permit Limit
-
15
50 or 100 see in)
sbo #1
3/19/15
No Flow
No Flow
No Flow
SDO #2
3/19/15
11.8
186
7.6
t 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 October 25, 2012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date 3/19/15 (first event sampled)
Total Event Precipitation (inches):.16
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 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE'OUTFALL? YES ❑ NO x
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, 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."
i
Lynne Hays For AT Williams Oil Company 4/17/15
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250 last revised October 25, 20t2
Page 2 of 2

EnviroLinc
Environmental Compliance Solutions
April 15, 2015
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject: Stormwater Discharge Outfall Monitoring Report
A.T. Williams Oil Company
General Permit Number NCGO80000 YlC(rYQ $Q �a8'
Please find enclosed the Stormwater Discharge Outfall Monitoring Report for A.T.
Williams site located at 1343 Rock Barn Road, Conover, North Carolina. The sample
results are for the stormwater outfall discharge points. If you have any questions please
contact us at [phone].
Yours truly,
4-,q-4 S
Lynne Hays
log Gentle Pond Court • Winston Salem, NC 27107 • Phone: [phone] • Fax: [phone]

mi-annual Stormwater Discha
e Monitorin
for North Carolina Division of Water Quality General Permit No. N
Date submitted 6/30/15
CERTIFICATE OF COVERAGE NO. NCG080428
FACILITY NAME WilcoHess Travel Plaza # 351
COUNTY Catawba
PERSON COLLECTING SAMPLES Lynne Hays
LABORATORY R&A Lab Cert #34 Comments on sample collection or
analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
COP*V
SAMPLE COLLECTION YEAR _2015
SAMPLE PERIOD xJan-June July -Dec
or Monthly' month
RCJ�I$�iGINGTOCLASS ❑ORW ❑HQW [—]Trout❑PNA
���/ I�: jj ❑Zero -flow ❑Water Supply ❑SA
JUL 0 6 2015 ❑Other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
❑ No discharge this period'
Outfall
No
..,
_-: Date
Sample Collected,
�.,..
=. 00530
Total Sus ended
,. P
..Solids, ng/L -s.
00400ISLOO55G
° H,
" P
:'Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT�H_EM}, mg/L
New Matar Oil Usa e,
g
Annual average gal/mo
BenEEm k�
Wkl ="
50�oi^ 100 see permit
Within 6.0 — 9.0
15 Y
-
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? x yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Ouffall
No..;
_: DDate
p
5am le Collected,64
00556 x
00530 :,
00400
Non-Polar Oil and Gre'"ase/TPH EPA Method
(SGL
L�ears%lids,
Standard units _
Permit Limit
50 or 100 see permit
6.0 — 9.0
SDO #1
N/A
N/A
N/A
N/A
SDO #2
January -June 2015
No Discharge/Inability to Collect Sample
No Discharge/Inability to Collect
Sample
No Discharge/Inability to
Collect Sample
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 October 25, 2012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date Jan -June 2015 (first event sampled)
Total Event Precipitation (inches): 0
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 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 li SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO x
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 a!! "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring period in
the case of "No Discharge" reports] to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Lynne Hays For AT Willi
(Signature of Permittee)
(Date)
Additional copies of this form may be downloaded at: httpjjportal.ncdenr.org/web/wq/ws/su/­npdessw#-tab-4
S W U-250 last revised October 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
CERTIFICATE OF COVERAGE NO. NCGO80428
FACILITY NAME AT Williams Oil Co. 4351
[Pilot Travel Center— Store 7971)
COUNTY Catawba Count__
PERSON COLLECTING SAMPLES NA
LABORATORY ESC Lab Cert. # 375
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2016
REC OW(PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly( (month)
FEB 2 g1S. ,"RGING TO CLASS ❑ORW ❑HCtW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
CENTRAL FILES ®Other Class C; NSW
DM SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
, DECEIVED
Did this facilit
y 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
CENTRAL FILES
No dischargMVM 8ErMN
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 100 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)
duifall
No.
Date
Sample Collected,
mo/dd/yr
OOS56
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 106 see permit
6.0 -- 9.0
Outfall No. 1
12/31/2016
1 No Sample
No Sample
No Sample
1 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 or2

STORM EVENT CHARACTERISTICS:
Date NA (first event sampled)
Total Event Precipitation (inches). NA
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 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE .CONTACT NAME:
Mail an original and one_coj2K 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 Discharae'reporo) 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 perrssonnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directl n sponsibletfar gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there significant penalties for -submitting false information, including the possibility of fines and imprisonment for knowing violations."
Permitteej
-212=�A6
(Date)
Additional copies of this form may be downloaded at: http:l/portal.ncdenr.org/web/Wdws/su/npdesswgtab-4
S W U-250
last revised April 11. 2013
Pay=e 2 of

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 6/2/16
CERTIFICATE OF COVERAGE NO. NCG080428
FACILITY NAME Speedway Travel Plaza
COLINTY Catawba
PERSON COLLECTING SAMPLES Lynne Hays
LABORATORY R&A Lab Cert #34 Comments on sample collection or
analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR �2016
SAMPLE PERIOD X Jan -June July -Dec
or Monthlyl (month
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
RECEIVED ❑Other
JUN 0 6 2016 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES ❑ No discharge this period'
DWR SECTION
Ou�fall• �
No -.
ya�ie
Sample Collected,
T to a1Susended
p
,'H,
Nan P�olaa r Oil ' Gree'�/TPH EPA
..:New Mator Oil Usa e,
g
F
mo%dd/yr
Solids; mg/L�
aStandariilunits
"Method 1{G HEMj, mg%L _
Annual ar►erage gal/mo
Bench a is-
„-�..
50 or.1�00`see ermit'
- p
_
Within'6:0 — 9.0
'
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? yes v n�
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall:..
.r
- Date
`Colleccted,N'on
'•-`` i '
mo/._dd/y_c
4 . 00556 u,F
0530 d.
M ,9 00400
Polai OilsandG er ase%TPH fPAtMe oth d
9�'..: `:' 1664 (SGT�HEIVI), mg/L';.
Ta al)5uspended Solids,{'
.. g r,'"•
mg/L _ -
y pH, t
- -.-
Standard units.A
PerrnrtL�mit
''- `
.;
w15 N
_
50ior 100 seep rriit
6 0 - 9 0
SDO #1
4/17/16
<5
17.2
6.7
SDO #2
4/17/16
<5
107
6.7
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 October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 4/17/16 (first event sampled)
Total Event Precipitation (inches):.28
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 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO x
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an orirLinal and one copy of this DMR�including all "No Discharge" reports, within 30 days of receipt of the lob results (or 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, 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."
Lynne Hays For Speedway LLC 6LL16
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/­wq/ws/s /npdessw#tab-4
SWU-250 last revised October 25, 2012
Page 2 of 2