NCG060034_MONITORING INFO_20140616

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v 00 ,?j y
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ a� I � ti �4 I (..4
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted June 16, 2014
CERTIFICATE OF COVERAGE NO. 14CG06 0 0 3 4 SAMPLE COLLECTION YEAR 2014
FACILITY NAME Hospira, Inc. (Rocky Mount. NCI FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Nash ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Mike Lewis DISCHARGING TO SALTWATERS? []YES ®NO
LABORATORY Pace Analytical Lab Cert. # 67
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE ->
Total event rainfall 2 2.1 or ❑ No discharge this period'
Outfal[No.
-Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform 1,
Colonies per 100 ml
Enterococci ,
Colonies per 100 mi
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
500
004E
05/15/14
23.6
6.84
99.0
<5.0
N/A
N/A
005
05/15/14
10.0
7.47
29.0
1 <5.0
N/A
N/A
017A
05/15/14
57.0
7.88
41.0
<5.0
N/A
N/A
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
45ee General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ® no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 504
6.0 — 9.0
-
N/A
N/A
N/A
N/A
N/A
N/A
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if yes. complete Part B)
RECEIVED
JUN 18 2014
CENTRAL FILES
DWQIBOG
SWU-249 Last Revised: October 18, 2012
Pagel of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCE£DENCES 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: N A
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.oriz/web/wa/ws/su/„npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2 of 2

(�' laneAnalyfical°
wwwpacewmcom
Eric Ferrell
Hospira, Inc. -Rocky Mount, NC
4285 N Wesleyan Blvd.
Rocky Mount, NC 27804
Project: STORMWATER
Pace Project No.: 92201740
Sample: POND 004 - B
Laboratory Report
Pace Analytical Services, Inc.
6701 Conference Drive
Raleigh, NC 27607
(919)834-49B4
Page 1 of 1
Report Date: 05/29/2014
Date Received: 05/16/2014
Lab ID: 92201740001 Collected: 05/15/14 16:26 Matrix: Water
Parameters
Results Units
Report Limit
Analyzed Qualifiers
Oil and Grease
ND mg/L
5.0
05/20/14 09:47
Total Suspended Solids
23.6 mg/L
5.0
05/17/14 10:23
Chemical Oxygen Demand
99.0 mg/L
25.0
05/29/14 15:30
Sample: POND 005 Lab ID: 92201740002 Collected: 05/15/14 16:38 Matrix: Water
Parameters Results Units Report Limit Analyzed Qualifiers
Oil and Grease ND mg/L 5.0 05/20/14 09:47
Total Suspended Solids 10.0 mg/L 2.5 05/17/14 10:25
Chemical Oxygen Demand 29.0 mg1L 25.0 05/29/14 15:30
Sample: POND 017A
L.ab ID: 92201740003 Collected: 05/15/14 17:23 Matrix: Water
Parameters
Results Units
Report Limit
Analyzed Qualifiers
Oil and Grease
ND mg/L
5.0
05/20/14 09:49
Total Suspended Solids
57.0 mg1L
12.5
05/17/14 10:22
Chemical Oxygen Demand
41.0 mg/L
25.0
05/29/14 15:30
Reviewed by:
Kelly Dillon
Raleigh Certification IDs
6701 Conference Drive Raleigh, NC 27607
North Carolina Wastewater Certification #: 67
Charlotte CerUfication IDs
9800 KinceyAve. Ste 100, Huntersviile, NC 28078
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
South Carolina Certification #: 99006001
Asheville Certification IDs
2225 Riverside Dr., Asheville, NC 28804
FlorldatNELAP Certification #: E87648
Massachusetts Certification #: M-NCO30
North Carolina Drinking Water Certification #: 37712
North Carolina Bioassay Certification #: 16
North Carolina Drinking Water Certification #: 37731
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
West Virginia Certification #: 357
VirginiafVELAP Certification #: 460221
North Carolina Wastewater Certification #: 40
South Carolina Certification #: 99030001
West Virginia Certification #: 356
VirginialVELAP Certification #: 460222
Page 1 of 4

56gnalytca!` Chain of Custody q2M�,0
Report Results to: Bill Results to: EI standard Report Delivery
Hospira-Rocky Mount Hospira-Rocky Mount � ❑ Rush Report Delivery (w/ surcharge)
PO Box 29055 PO Box 29055 Ar Requested Due Date:
Hot Springs, AZ 71903 Hot Springs, AZ 71903
Project Reference: StormVRtey� c
ATTN: ;Pip r--1,Af 4z � r-S ATTN: 46eferrcll /�%�/�� L /S Purchase Order #: C
Phone: Sampled By: "'w
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•il & Grease, Total Suspended,•1
Oil & Grease, Total Suspended, COD
M:Oil
& Grease, Total Suspended, COD
(methodMOEN Hg 1631E),Cyanide, Phenols
MENE
U;&W
#1
For Lab Use Only
Temp erature at receipt:
RE �-- mf;,
ftzoulshed by (signature)
by (irlyi0ref -7
=wTemp;
co

Document Dame: Sample Condition Upon
Document Revised: AE13
aceAraalytical
Recei t SCUR
Page 1 of 2
Document No.:
issuing Authori
1-
'
F-RAL-CS-001-rev.02
Pace Asheville Qua
Client Name: R�'vm
Where Received: Huntersville [] Asheville ❑ Eden Ralelg4
Courier(Circle): • Fed Ex _ UPS_ USPS Client Commercial a .Other
Custody Seal on Cooler/Box Present: El yes no Seats intact: yes ❑ no
Packing Material: Bubble WrapBub a s e Non Other
Circle ThermometeUsed: IR Gun 5 . 5 yp of Ice: Blue None [ Samples on ice, cooling process has begun
IR Gun Back Ut). SN:122485371
Temp Correction Factor: Add I S (P-4 ( C
Corrected Cooler Terr3p.: C Biological .Tissue Is Frozen: Yes No
Temp should be above freezing to ST Comments:.
Date'and fnitWo of person exarnlning
contents! ary
check:
Cheln of Cdstody Present -
Yes i]No - OVA-
1 _ _-_-- _-. ..........
.. .... _.._ ._ ....._ .,_....
Chain of Custody -Filled Out
XYer ONO
OMA
2.
Chain of Custody Relinquished:
Yes .❑No
❑NL-
3.
Sam er Name 8 Signature on COC:
Yes ONo
ONLK
4.
Sam es Arrived within Hold Time:
Yes ONo
❑WA
5.-
Short Hold Time Analysis (<72hr):
Dyes KNo
MA
6.
Rush:Turn Around Time Requested:
OYes gNo
❑NfA
i.
Sufftcient Volume:
eYas ❑No
❑MA
8. -
Correct Containers Used:
-Pace'Containers Used:
es ONO
e9 ONO
❑MA
❑NfA•
9. '
Containers intact:
es ❑No
11WA
10.
Filtered voiume•teoelved for Dissolved tests
❑Yes ONo
^A
11,
Sample Labels match COC:
-Includes-date/time/lD/Ana[ysis Matrix
lea ' ONO '
-Q WA
12.
All containers needing preservation have been chedced.
Ail oontalners needing preservation are found to be In
compliance with EPA recommendation,
a�mepitons: yOA, goIiform. TOC, O&G, njREO )
es ON-
,911e9 - ONo
--dYss ONO
OMA
(aMA
13.
Samples checked for dachlorination:
OYee ONO
EeA
14.
Headspace in VOA Vials { >6mm):
' OYes ONo
01A
15.
Trip Blank Present:
Trip Blank Custody Seats Present
Pace Tri Blank Lot # (if urchased):
❑Yes ❑No J;6aA
©Yes ONo .OWA
16.
Client Notifi,cationl Resolution: Flald Data Required?, Y V N
Person Contacted: Date/Time:
Cornmenisl Resolution:
SCURF- 1811E 1a1 J Place label here
Date. - _
Review::
Note: Whenever there is a discrepancy affecSng North Carolina ooTnpliance (WO#:92201740
;-
samples, a copy of this form vAT be sent to the North Carolina DEHNR
Certification-Office-(i.e ouroarect containers hold. incorrect proservc"Ne, out of temp,���k�kl
I Ii)I
Page 3 of 4

Document Name: Sample Condition Upon
Document Remised: April 04, 2013
Receipt SCUR
Page 2 of 2
�`
Document Na.;
Issuing Authorities:
F-RAL-CS-001-rev.02
Pace Asheville Quality Office
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Client Sample ID s
Sant le bIsere 6n
H Adjustment Log for Preserved Samples
Sample ID
Type of
Preservative
PH upon
receipt
Date preservation
Adjusted
lime Preservation
A tmt8 i
Amount of
Preservative added
Lott of
Preservative
Bottle Code Key
125 ml Plastic Unp: 8P4U
250 ml Plastic Unp: BP3U
500 ml Plastic Unp: BP21J
1 Liter Plastic Unp: BP1ll
250 ml PlasticH2SO4: BP3S
250 ml Plastic HNO3: BP3N
250 ml Plastic ZN Acetate: BP3Z
21,0 ml ►Mastic NaOH: BP3C
WIde mounted glass jar unp: WGFU
1 Liter. Amber Unp: AG1U
1 Liter Amber HCI: AGIH
500 ml Amber Unp: AM
1 Liter Amber H2SO4: AG 1 S
250 ml Amber H2SO4: AG3S
250 ml Amber NH4CL: AGM
40 ml VOA HCI: DG9H
40 ml VOA Na2S203: VG9T
40 ml VOA Unp: VG9U
40 ml VOA H2SO4: DG9S
50351% VOAK
VPH 1 Gas Kit. VIGK
125 ml Sterile Plasfic: MT
250 ml Sterile Plastic: SP2T
Page 4 of 4 -

Hospira
June 16, 2014
NC Department of Environment and Natural Resources
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Attention: Central Files
Subject: Discharge Monitoring Reports
NPDES General Permit No. NCG060000
COC# NCG060034 (R1/R2)
Hospira — Nash County
To Whom It May Concern:
Per the requirements of our general stormwater permit, the following
documentation is attached for your review:
✓ Storm water Discharge Monitoring Reports for Outfalls 004B, 005, 017A
✓ Certified laboratory report
All required discharge characteristics (total suspended solids, pH, oil and grease,
and chemical oxygen demand) were within permitted ranges. Total rainfall was
measured with an on -site rain gauge for the duration of the event. We will
continue to conduct future sampling events based on the conditions indicated in
our permit.
Please contact me at [phone] if you have any questions.
Sincerely,
Kevi . Levesque, P.E.
Senior Environmental Specialist
Environmental Health and Safety
Hospira, Inc.
4285 N Wesleyan Blvd
Rocky Mount, NC 27804
[e-mail]
Enclosures
F.O. Drawer 2226 Pocky Mount, NC 27802-2226 252/977-5111