NCG060168_COMPLETE FILE - HISTORICAL_20190620

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV U& D (op 1L Y
DOC TYPE
4� HISTORICAL FILE
b' �MONITORING REPORTS
OOC DATE
� a�► 9 0lop a o
YYYYMMDD

STORMWATER DISCHARGE MONITORING REPORT � _
for.North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCGPOQ,EIVED
Date submitted
CERTIFICATE OF COVERAGE NO. NCG060 1 4P S
FACILITY NAME 6AAA UEE rk aZEN BA-44616y LLC-
COUNTY r�d- _j
PERSON COLLEeTING SAMPLES TyliJ G414r0 MA-r-) J72,
LABORATORY ZJ0f 2 VJ/r 0;Q E Lab Cert. # OfIf 9 D
Part A: Stormwater Benchmarks and Monitoring Results
JUN 2 0 nig
Q CENTRAL. FILES
SAMPLE COLLECTION YEAR o20 1 7 D1NR SECTION
SAMPLE PERIOD QC Jan -June ❑ July -Dec
or ❑ Monthlys {month)
DISCHARGING TO CLASS ❑ORW ❑HQW [—]Trout ❑PNA
❑Zero -flow [—]watersupply ❑SA
❑Other
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE -)
Total event rainfall z # q1 or ❑ No discharge this periocP
Outfall No a:
e.
,.„ Date Sample
t
Collected; molddl r.
4,; `TSS,
mg/i
; pH;
Standard urilts
COD, ;•
nigJL '
`Oil and Grease, '=
mg7L
' Fecal Collform,
Colonies er 100 rtil,'
- Enterococd, ,a
Colonies tier 160 ml`
Benchmark ,. ,,
.. .
i .i
100 or,504
Within 6.0 — 9.0
120
30
10001,
5oo1
Parometer,Code.
,' • .:• -.... - ' • .:
:C0530
00400
00340,
00556
31616
61211. .
t
s
�. s
#
31
< 20
s
1 q
«. S
< ago
S
31 Z12
Ka.
8
021
<5
7;+S1
31
a2. 7
to. q3
< AV
<
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from.an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes ®no
Permit Date: 11/1/2018-05/31/2021
(if ve complete Part B)
SWU-249, Last Revised 11/5/2018
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Date Sample Collected
(mo/dd/yr)
24-hour rainfall amount,
Inchesx
New Motor Oil or '
Hydraulic Oil Usage
Non -Polar O&G/Total
Petroleum Hydrocarbons
Total Suspended Solids
Benchmarks
-
-
15 mg/L
100 mg/L or SO mg/L°
Parameter Code
-
46529
NCOIL
00552
C0530
Footnotes from Part A also apply to Part B
"I
*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 ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR, Including all "No Discharae" reports, within 30 days of receipt of the lab results for at end of monitoring period in the case
of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
w
You MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under. penalty of law, that*this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that,qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who
manage the system, or those persons directly responsible'for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations."
Signature of
Permit Date: 11/1/2018-05/31/2021
f
Date
SWU-249, Last Revised 11/5/2018
Page 2 of 2

. t r
Envimnmentat
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/C/Z! / O/&/ U/ 0/0/ U/ or Certificate of Coverage No.: N/C/G/ Q` (v/ O/ 1 /(p I ;?l
Facility Name:
County: C
Inspector:
Date of Inspection:
Time of Inspection: p2 D : 3 O
Total Event Precipitation (inches): /+ 021
I
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature ofVWitte—eOrAW
ghee)
1. Outfall Description: j II-
Outfall No. T Structure (pipe, ditch, etc.): �1 TCi't
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Pagel of 2
SWU-242. Last modified 06/01/2018

2. Color: Describe the color of the
(light, medium, dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): _- Al-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
2 3 4 .5
5. Floating Solids: Choose the number which best describes'the'amouni of floating solids in the
stormwater'discharge, where 1 is no solids and 5 is the surface covered with floating's6lids:-
2 3 4 5
6. Suspendcd Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
7.
8.
9.
2 3 4 5
Is there any foam in the stormwater discharge? 0 Yes • No.
Is there an oil sheen in the stormwater discharge? oYes ® No.
Is there evidence of erosion or deposition at the outfall? O Yes • No.
10. Other Obvious
`Indicators of Stormwater Pollution:
List and describe /NIaNE
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

Ice..
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https:I/deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N_1C16101(b161d101 O/ or Certificate of Coverage, No.: NICIGI (71&10/ 1 /&/ 81
Facility Name: �SARA L66 1::Ro ZED HA kE M U.C.
County: 6dgECOA UC Phone No. o'%sa'Z '_la�i%%,- ��
Inspector:N
Date of Inspection: S-- 31 q
Time of Inspection: � OO
Total Event Precipitation (inches):
/. 07
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
99
(Signature of P�ittee
1. Outfall Description: 1
Outfall No. C9 Structure (pipe, ditch, etc.):
Receiving Stream: ---,
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
$WU-242,Last modified 06l0112018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: el-7"&
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
4, Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy.
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 .3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1� 2 3 4 5
7.
S.
9.
Is there any foam in the stormwater discharge? 0 Yes s No.
Is there an oil sheen in the stormwater discharge? gYes • No.
Is there evidence of erosion or deposition at the outfall? p Yes 0 No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe 6& IJ E
4
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

lcv-
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on fling out this form, please visit https://deq.ne.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: NICI6I0/w/ O/ 0l0101 or Certificate of Coverage No.: N/C/G/d16101 / l wl Rl
FacilityName: 6A A L66 rle0 ZEN R&K -ER sA L - C
County: ,*-d Phone No. 02S�- (0 5/ %- C93o 9
Inspector: 1�}
Date of Inspection: —
Time of Inspection: r-20 ; [D
Total Event Precipitation (inches): / • C91
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Pj�{mittee or
1. Outfall Description:
Outfall No.
Receiving Stream:
Structure (pipe, ditch, etc.): l ��
Describe the industrial activities that occur within the outfall drainage area: R4 K90 6bui t
Page 1 of 2
5WU-242, Last modified 0610112019

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: �ove_
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.). MODE
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
0 2 3 4 5-
5. Floating Solids: Choose thm e number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered witA floating solids.
2 3 4 ' 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. is there any foam in the stormwater discharge? « Yes 0 No.
8. Is there an oil sheen in the stormwater discharge? ©Yes # No.
9. Is there evidence of erosion or deposition at the outfall? O Yes 0 No.
10. Other Obvious In�di)cators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
Sw1]-242, Last modified 06/01/2018

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Repori-
For guidance on filling out this form, please visit https:Hdeq.nc.govlabout/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N_ICI 6T/ O/&/. O/ D/C,l O/ or Certificate of Coverage No.: NIC/GI 61.. G.61 1 l (ol R/
Facility Name: 6migE F 02 /0 9A
,I.L d n
County: Lds;so%EdM Phone No. 12 3d
Inspector: _ � hp� 1 t�7 � IJ 09
Date of Inspection: nr-
Time of Inspection: 1j
Total Event Precipitation (inches): I , oG _
;Q.
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the' -best of my knowledge:
r '
(Signature of Permits or DesignAl
s,
1. Outfall Description:
Outfall No. Structure (pipe, ditch, etc.):
Receiving Stream: 71Z A a
Describe tth industria activities that occur within the outfall drainage area: ti
Pagel of 2
SWU-242. Last modified 0&0V2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C 16w
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): NO Ill E w_�
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
2 3 4 5' _
• 5. Floating Solids: Choose the number which best describes the amouni of floating solids in the
stormwater discharge, where 1 is no soiids and 5 is the surface covered with floating solids:
Q 2 3 4 ,5
G. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
[V 2 3 • 4 ' ' 5
7.
8.
9.
Is there any foam in the stormwater discharge? O Yes • No.
Is there an oil sheen in the stormwater discharge? QYes o No.
Is there evidence of erosion or deposition at the outfall? Q Yes +W No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe %ID/16,
%a
Note: Low clarity, -high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 06/01/2018

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring -Report
For guidance on filling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stonnwater-gps
Permit No.: N_ICI 6101.61. 01.01.01.01 or Certificate of Coverage•No.
Facility Name: 6RgA L66 r7�0 ZE#0 1 A k61
County: _ _C—_JQ 6'c6e b E . Phone No. C> S_c
Inspector:
Date of Ins
Time of Inspection: c7
Total Event Precipitation (inches):
AJ7
NICIGlt&, 01 1l (sl ?
=-&ell- '23,
All permits require qualitative monitoring to be performed during a "treasurable storm event."
A "measurable storm event' is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of P)E6nittee or
1. Outfall Description:
Outfall No. �5
Receiving Stream:
Structure (pipe, ditch, etc.):
Describe the industrial tivities that occur within the outfall drainage area: �
E& t Grit 7
Pagel of 2
SWU-242, Last modified 06JO112018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C146#g.
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): _ /VONC_
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount'of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:''
lQ 2 3 4 5 t
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Q Yes • No.
S. Is there an oil sheen in the stormwater discharge? oYes • No.
9. Is there evidence of erosion or deposition at the outfall? O Yes aP No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe ! V P 1,46-
Note: -Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, last modified 06/01/2018

�uQo����`90 I�c�oQ�oQ�4o�
rryt�l�tta �;strtts s
g.
X 125217Sfi 33_
IDit 449 D
311LLSHIRE BRANDS
1
ATTN: MR. JOHN H. CHAPMAN,
Jib.
10'SARA LEE ROAD
DATE COLLECTED: 05/31/19
ARRORO ,NC 27886
DATE REPORTED
: 06/10/19
REVIEWED BY:
Stormwater
Stormwater
Stormwater
Stormwater Stormwater
Analysis., :
Method
PARAMETERS (#1, Grab)
(//2, Grab)
(#3, Grab)
(#4, (;rab) (#S, Grab)
Date. Analyst
Code t�
COD, mg/1 40
<20
<20
21 <20
06/07119 SEJ
RS000-79
Total Suspended Residue, mo <2.5
<2.5
<2.5
<2.6 <2.7
06104/19 MAR
2540D-ii
Oil & Grease (HEM), mg/1 <5
<5
<5
<5 <5
06/04119 SEJ
1664B

Fnvironment I; Inc.
P.O. Box 7095,114 Oakmont Dr.
(;raxiriiriHra 1�f-?7St5Si
CHA114 OF CUSTODY. RECORD
- r
I 1
.Page df
environment l inc.com
Phone (2- 208 Fax [phone]
'DISINFECTION
CHLORINI NEUTRAL [ZtD AT ODLI t Ct1ON
.
CHLORINE
-
CLIENT: 449 D woelc:
W
[�
00,
F
f
pH CHECK (LAB)
P
P
G
{
CONTAINERTYPE,PIG
JLLSHIRE BRANDS
j� NONE
,TTN: MR. JOHN H. CHAPMAN, JR.
+�
C
A
C
giEBVIICAL PRESER4IATION
IO.SARA LEE ROAD
ARBORO NC 278%
❑
A•NONE, D-NAOH
-u.
t52) 641-2308
�
� B-.fiNO, E•HCL
-
C - HpSO, F - ZINC ACETATENAOH
COUSICTION
'`
O
•�
Ca
O
G-NATHIOSULFATE
SAMPLE AT ION'
DAIS
TIME
o
a
a`r
Stormwater W, Grab)
3
CLASSIFICATION;
WASTEWATER.(NPDES)
DRINKING WATER
Stormwater (#2, Grab)
/ i
04: Sip
.3
Stormwater (0, Grab)
3
Stormwater (#4, Grab)
-7-0
3
DWOM
t'J
SOt.ID WASTE SECTION,
Stormwater (#S, Grab)
v70 :
-
3
CHAIN DI CUSTODY (SEAL) MAINTAINEQ{
-
DURING PMEM7DELIVERY
Y N
SAMPLES COLLECTED 8}!
-
i Print)
... I
t
SAMR.ES RECEM IN LQ AT . 2 . - .3 -- °C
ATErnmE -
IVY,
A 'CONMBY ( )
DATI JitHtE
COMMENTS:
SHED BY )
J OATEn ME
'RE BY (SIG.)
DATErTIME
BY (
AiFJIIME
Y (
DATE/rIME
PLEASE READ Instructions`for completing tfils�fokm on the reverse
FORM NS side..
Sampler must place a "C" for composite sample or a V for p;
Grab sample in the blocks above for each parameter requested. • 73

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING
for North Carolina Division of Water Quality General Permit Nq0.VPq0Wq00
Date submitted I IL tj culu
CENTRA FILES
CERTIFICATE OF COVERAGE NO. NCG060168 SAMPLE COLLECTION YEAR D�ft� ITIMi
FACILITY NAME Hillshlre Brands Company, Tarboro Plant FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Edgecombe-. ❑ use/process meats El use animal fats/byproducts
PERSON COLLECTING SAMPLES , )TTJ L_Raam_rblz DISCHARGING TO SALTWATERS? []YES ffN0
LABORATORY
Lab Cert. # __!i�2
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 2 *742 or r7 No discharge this period'
'afil i140"il
,aSampwcol ec •.ea�v-I.. o
Pt- Willi
0
ftt�� �b�,�,, 't"L�-.F�.'F"?'i?„'�`.
�".+,�.
tan
"tan
'COX �11_
�0'2'011,6ndGr6i6
`� , r�
�,ColonlesjlJ0 100,-,
r
ni
I
, 04
K-4
`fldMtRMA
-7
<ao<
<
07-<0
-7,
.24-D
Sao
R. !9
6 li4?
<AO
57
J—
Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 3, Identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? El yes 9 no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
0.
�! 01 "
P.
Oil, r
as �-4
S irn0Ie',,CdIl'6'2td'
S,
N R motclel)
ar
n R r W,
�k'gj
M " .
;S , �5
'64 m
ME �1.k - 'NuL
� � -%�fi �, � X
n t 'K, AM
St nd a rq�u n1ts,,
t I
�i 'Y'qe rpo Usage,
" , 111" 5IT
- I. S
n
12 u 6 �la v
J!Le 7, �A n U a 1.
(if yg, complete Part 13)
I Only applies to facilities that use/process meats.
2 The total precipitation must be recorded using data from an on -site rain gauge.
1 For sampling periods with no discharge at Any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012
Page 1 of

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO 0
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" xeports, within 30 days of recelpt of the lab results for at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUSTSIGN 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."
1
(Slgnaturg of Permittee)
Ll- ,-/0
(Date)
Additional copies of this form may be downloaded at: http:/1pgrtA1,ng eRr.orelweb/_w__Ct w it a -4
SWU-249 Last Revised: October 18, 2012
Page 2 of 2

MWONIMUM �n rp
® mbd
HILLSHIRR BRANDS
ATTN: 'MR. JOHN H. CHAPMAN, JR.
110,SARA LEE ROAD
TARBORO ,NC 27886
PARAMETERS
COD, mg/l
Total Suspended Residue, mg/l
OR & Grease (HUM, mg/l
ID#: 449 D
DATE =LLECTED: 10/26/18
DATE REPORTED : 11/05/18
REVIEWED BY:
Storriiwater
Stortnwater
Stormwater
Stormwater
Stormwater
Analysis
Method
(#1, Grab)
(#2, Grab)
(#3, Grab)
(/14, Grab)
(#5, Grab)
Date Analyst
Code
<20,
<20
C20
<20
<20
11/01/18 SEJ
$8000-79
<2.7
<2.5
2.6
<2.5
<2.5
10/31/18 JTH-
254OD-11
<5
<5
<5
<5
<5
11/€12/18 SEJ
1664B

Environment I jnc.. CHAIN OF CUSTODY ;RECORD_
P.O. I3ox 7+185;114: Oakmont Dr.
ArRrnvillr NC" 3']ASft Pape _1;. of- 1
environment.linc-com
Phone (252) .a65=nzv • Fax [phone]
CLIENT: 444 j Week: 32
DISINFEC-11014
CHLORINE
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GOMAERTYPE,P1Cx
HLLSHIRE $RANA$
LTTN: MR. JOHN H. CHAPMAN, JR.
.10 SARA LEE ROAD
rA"ORO NC 27886
NONE
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CHEMICALPRE.SERVA"nON
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252) 641-2308
COLLECTION
La
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Up
€
'
B - MNO, E - HCL
C-H SOS �F --ZINC ACETATFJNAOH'
g G - NATHIOSUTATE
'
SAMPLELOCATEON
DATE
TIME
q,
h
(
CLASSIFICATIOR:
❑ WASTEWATER (NPDES)
!❑ DRINIUNGWATER
DWWW
F❑ SOLID WASTE SECTION!
ftratwater Vl,fimbl
w1tf
,",
4..
;
_
! yS
4..
�
I
Stongw ater 4 Grab
&Qrmja 5 rob
h
4'
1
d
_ter
CHAIN OFCUSTODY,(SEAL) MAINTAINED
_
DURIN&SH PMENT/DELIVERY
i
1
C 'N
SAMPLES Ot}t1.ECiz':D W.
- - .... -..- _
.. .-. _
..
... ...
,
(Please Print)
i
I
EE
SAMPLES RECEIVED IN LAB AT °C
�LOED B G.) (SAMPLER)
,0
A . E
A
D TEITIME
COMMENTS
"
\k
REt]NOUISHfD BY (51fl,)
DATEMME
(, {
ATE'ii1ME
_ _....
F;Ei 1Ndt L%fD BY(SIG-)
DATEMME
REMiVF.D EY (SIG4)
DATEITIME
PLEASE READ )n5truCtfQnS for CQ[raplEting ttiiS tQrm Qn.the:reVQrSe Side. ` Sampler mustjplace a "C" for composite sample or a "G :for
FORM 45 Grab sample in the:blocks above for each parameter requested: .N 2 3 5.3'3 4`2

NCDENR
Stormwater Discharge Outfall(SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: ht!p://porW.ncdeiir.oEodweb/,Aq/ws/su/npdessw#tab-4
Permit No.: NICI I_/ I 1 I I / or Certificate of Coverage No.: N/CIGIDI�IOI-LII_eI
Facility Name:
County: _ O,GCGd I e Phone No. 75X'a -
Inspector:�l
Date of Ins, -
Time of Inspection: _ 9. 457 AM
Total Event Precipitation (inches): • %a
Was this a Representative Storm Event? (See information below) DO Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or b4signee)
1. Outfall Description:
Outfall No. - L Structu (pipe, ditch, etc.) I r
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
3. Odor: Describe any
chlorine odor, etc.):
using basic colors (red, brown, blue, etc.) and tint
odors that the discharge may have (i.e., smells strongly of oil, weak
SWU-242-20120613
Page I of 2

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 .5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:,
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
ev
10. Other Obvious Indicators of Stormwater Pollution:
List and describe _/� t1 I n grgc
►,
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SwU-242-20120613

'Ha-H ,($DO)
A -
Stor.wwater. DW&W Ou
77 1
Me ng -p
tJLr.I 'ji
For guidance on fining out this farm, please visit. haw Mortaij
Permit No.: -NICI—/—/ Y'—/ I I / or Certifi a Cov
Facility Name -
County
-Ity-M afl!
Date of Ins6ection: '7g
T"me°of.kspecfion:
Total Event Precipitation (inches): U
Was this a Represefitative.Storm- Event? (See information helo,
Please check your permit to verify if Qualitative Monuo.' s nu
storm event (requirements vary).
No:: N/C1G/04— O/ -Llj&g
N�
No'
reprqsenIafive
A ,Representative Stem EvenC is a storm it thw-0.I.incbzs! . !a'nd that-,,
-AYMCt I
is preceded by at least 72 hours (3 days) in-wifich:no storm vent measuring has
occurred. A single storm event may containap.to IO'consap ve hours no pr
y uft of , -ecipitatiqn.
By this signature I certify that this. rt is accurate and mpletel to the best of, my.1;nowledge.-
VY
Permittee-qrDesib-
A
S (pipe, e.
R Stream: I
Describe.the indusUW activities that Occur within,the-6u d*'
2. Cwov.&Rmcdk,dieC,616r..*f.,&e4di=hu b ccA
(light medium dark), as descriptors:
II
brown, blue; etc;)=andTtint
3. Odor: Describe any diVinct odors that the discharg" -may have (Le -,.' smells .strongly of oil, weak
chlorim odor, etc.): MdAhC
Pa
SWU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
V 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where l is no solids and 5 is the surface covered with floating solids:
ra/ 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where l is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes 10
S. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
14. Other Obvious Indicators of Stormwater Pollution:
List and describe / ,q - zi5- - -
Note:' Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
Cwl I-242-20120613

Stormwater Mchar Waff (SDO)
-A,
AP ,.-� .A- s
For guidance on filling out this farm, please visit: h -1 I rtal.n lcdenr.ora web/w /ws/ u/n ssw#tab-4.
Permit No.: -N/C/_/ . I - /_I /_1or Certificate over' No.: N/C19a Q/ OI L/A/ Y/
Facwty Name:
ty Phone N`
u- w
Date of Lnspection: •
T"Ime - o€ Inspection: � _ E
Total Event Precipitation (inches): . 7a
Was this a Representative Storm -Event? (See infmmatiou low) Yes No
Please check your permit to verify if Qualitative �llo O must;lie per�o»ned &rLi a represerirative
�, x...., r.... r_,.,
storm event (requirements vary).
F
A "Representative Storey Evc0l is a -storm even#, tbatg-- ..... �greater?thau;il.l:inches: of raitrfail:aud, that
is preceded by at least.72 hours (3 days) in.which.no storm vent treasuring greater;thah 0:l inches has
occurred. A single storm event may contaiwup to -1( utive hours of no precipitation.
.�- 4:. � .ice � w � - �. ii�, � +�".:a .� d#tk :Y ••.i � 4 -4
By this signature, I certify that this.report is accurate and Iete to the best of my_icnowiedge:
(Si w Hof Permtttee ar Desi
Oudfail Desct-flora:
Outfall No. Strut t ditc etc. -
R�:eivingStream
Describe;the.ittd tstryal activities that occur withinthe -alidrayuageratea.
l
2. Color',,Describe the'color o£th_e' usyng,b Cfcolc#s�(red, Emciwn l�Iue; ctc�)''agd=ttnt
(light, medium, dark) as descriptors: _
. - I' i
3. Odor: Describe any distinct odors that the discharg may have (i.e.; smells -strongly of oil, weak
chlorine odor, etc.): IT
Pagexi.of 2;
SWu-242-20320613

4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
Q 2 3 4 - 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
10 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall? Yes (&
10. Other Obvious Indicators of Stormwater Pollution:
List and describe _ / UJ _tsa. tEr,
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
CWI1-242-20I20613

' IY w ., 5 � i. - 'lam , :�• .,:, t. ._ _. .��i:
_ +'- 1 S'7 - N- '' ~ 1. a �•• .. � • �: o dt•` a
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-
rrI
• �� 1* � _ 'fst )-t Gov jj I. � a"•yl aj .-`� � �.. iy���,k, t;
br re
Ali jd
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�CS
�J' `tirr t �5�.� f, x
�yyjl
.. ... v+ .l J K t t 1 J, '. ' { ; , �✓a'X",M.�q :i' '+ _I;A �- ' !f �I .......
.. }Y' i� Y�. 1 �S .{� !s ; Jf �i,if<gF,.J I iF- ,�V H .' _.�•1 ,{�a �+��y`
-'fa:.
--.ter{, v - � t f-., .. l i [+,.,' Jt : i� j: - .. � fk• .:.!•' .L:.._ -
�', �• '(�•i f i li f r: r J ^" � Pi r - tT ��' „s, l�vu . 4 0 .
{ '� � .hr.r.,- i • r`:_+a. {. Ft .. .�]'- 1 �,-.,t-• �. ' « '� lb. - 'y ;t ��i +{%' � } -r. -• +: �. :,+s t ��..
a '•' r-_ x ii' 7't- r F{` 7 1 �� L '1 '_� 1 _ r -. �i, � :'�ij •'^4 >V M <. -'�'
.. } i `•? r .'ie • •;' '' K 1� 1._ J: r .w•�.,v :Y: ti2.n .l'
-AWN t
`}�' ki s. - kk.<j•. 'S' '4 . _ N' 'd
-•. � i. -` � � 7..: r. r>":� cam; a� 1 5'S'+, -1i`r `<'4r] .-

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best4escribes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
S. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfali? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe _ / d L-z4 eE5
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2

. -F�CD_ _ R •
Stormwater Disc ` :r Oudati� (SDO)
QualitativeoIiAt0.4
porgy r nz_ :
For guidance on filling out this form,. please visit: h JI rtal.nMenr.ora wWn ws/su/n ssw#tab-4.
Permit No.,: -NICI I l_I_I I .l / or Certificate o v No:: N/GG/Q�4' � -b & V
Facility Name: -
County r Phone N
�'•
IusCtcir _ fLEI
Date of inspection: [ _
Time•of.Inspection:
Total Event Precipitation (inches): •�a
is �'. Y" -. ',�. -.r -. ..x. :. � d •`_ -`-. i`x"'j za .. e.
Was this a Representative Storm -Event? (See information low) Yes 1 ❑ No Y
Please check your permit to verify if Qualitative Morita, ' Waw. performed dtir ngs a.;representative , }s'
storm event (requirements vary).
i
A "Representative Starzn Eve' is a storniAypnt tbatq zgzeaterstltan,O.Iiinches�of rainfall;and that-'
is preceded -by -at Least 72 hours (3 days) in:which>no sEEye
nt touring greater tiia;i 0: inches has
occurred. A single storm event ma
gl .y contai ,up to 10 boors of 66 precipitation.
By this signature, I certify _that-thi, report is accurate and - ietelto the best of•my�nowledge:
..r ... ..... - .:-!/•-_......� .^-...__. _„. .- .,..,� ., ._.ram, , .� ..>.._ - +^Lk s�„y vi.-!
(Signattire Permittee ar Design _ _ .
Strcte_ peChMall No ccth, etc.), _
Receiving Stream:
Describe. �mdus activities that Cf-„ within�e-ou,- , drainage�area.
2. Cal6rII3escr tt ,the;coiorof ::b &colds rec ;brown, blue tetc )hand tint --
(light, medium, dazt) as descriptors:
f
3. Odor: Describe any distinct odors that the disc tiarget may heave (Le.;:smelis strongly of oil, 'weak -
chlorine odor, etc.): AJA61e1 -
it
swu-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
6) 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
6 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
V 2 3 4 5
7. Is there any foam in the stor nwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stornawater Pollution:
List and describe / Ud J<'<-r9CE
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
ewi 1-242-20120613

CERTIFICATE OF
FACILITY NAME
COUNTY
PERSON COLLE
LABORATORY_e
Part A: 5tormwater
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPO CEIVED
for North Carolina Division of Water Quality General Permit No. NCGO60000 1 2018
r n Date submitted DY n
N0. NC 306j) w SAMPLE COLLECTION YEAR _ on 2 V I CENTRAL FILES
- - - ±,3JirR SECTION
FACILITY ACTIVITIES INCLUDE (check all that apply):
.j ❑ use/process meats ❑ use animal fats/byproducts
LES DISCHARGING TO SAI.TWATERS? [_]YES ®NO
m .7-Lab Cert. g_
marks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event ralnfa112 E 3 a or No discharge this period3
Outfall•No
`Saenpi `CoHecd;
/dd% r
'm 1.
`Standarilunits
COD,,.,
`:m" L
:011 and:Grease
L
Feel`Coiifvrm , te;s'
Coloni@s• r._IOQ.mI
E Eote�ocaccI
.;'.0lgnles+ gr`i¢O,mlr;,
Benchmark
,•SOD o� 50 =
ilVithfn'S0 -9;0 °
20
30
' 1000
500-; ,
- -
/V
3
<S
-
a
S
-It<.2
X-AW1
�a
S
3. a
o'2o
S
' Only applies to facilities that use/process meats. T
2The total precipitation r iust be recorded using data from an on -site rain gauge.
3 For sampling periods wi th no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perfor, Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Mainti nance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
OutfDll''No. }
z Sam le' Calfected„
d1`. '
on ��,d a a , ,�
�, '.,y;:,
" TSS,
`•" = rrig/! �z.ti:=5faitlard
pH,
ie •)- - -,.,t .. e- s
units
New Motor OII Usage,
�. �. :a. yv :•..;;�F.
�,:Anrivahave�a e; ' i%rno 3
Benchmark
-
30
100 ar 50
61.0 - %0
-
(ifyes, complete Part B)
Only applies to facilities that use/process meats.
2The total precipitation ust be recorded using data from an on -site rain gauge. `
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART R 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 orl anal and one cony of this DMR including al! "No Dischar e" re orts within 30 days of recel t of the lab results for at end o
monitoring eriod in the case o "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, thatthis document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information 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."
�-1
.z
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Nap. ? of 7

m a !1 n w f7
BILLSHIRE BRANDS
ATTN: MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD
TARBORO ,NC 27886
ID D
DATE COLLECTED: 04/24/18
DATE REPORTED : 05/01/18
REVIEWED BY:
Stormwater
Stormwater
Stormmwater
Stormwater
Stormwater
Analysis
Method
PARAMETERS
(#1, Grab)
02, Grab)
(#3, Grab)
(#4, Grab)
05, Grab)
Date
Analyst
Code
BOD, mg/l
26
19
30
<2.0
<2.0
04/25/18
HMM
521OB-11
COD, mg/l
34
32
37
<20
<20
04/27/18
SEi
HS400-79
Total Suspended Residue, mall
19
11
11
<2.6
3.2
04/26/18
RDS
254OD-11
OR & Grease MAQ, mg/I
<5
<5
<5
<5
<5
04/27/18
SEi
1664B

Environment 1,1nc.
V0. Box 7085, i 14 Oakmon Dr.
Cireenville. NC 27858
CHAIN OF CUSTODY RECORD
Page I of. 1
envi marnent I i ne.com
Phone (252) 756=62D8 • ax
CLIENT. 449 D
U LSMM BRANDS
►TTN: MR. JOHN H. CHAPiI
.10 SA.RA LEE ROAD
7 ARRORO NC 27896
252) 641-2309
252) 756-0633
eek: 6
, JR.
DISINFECTION
❑ CHLORINE
❑ Iry
❑ NONE
❑
CHI.()RIfVENEIlTi�/W�DATCOilECTION
pH DECK (LAB)
P
P
P
G
OdNiAq+IERT(PE,P,'G
A
G
JA
C
CHEWCALPRESERVATION
A -NONE D-NAOH
- HNO, E HCL
Cr¢
�' C - ItSO F -ZING ACETATEINAOH
G - NATHIOSULFATE
a
i
cc
Q
4
a
4
A
A
OV
a
N
9
C
c7
O
OOLLECTION
SAMPLE LOCATION
DATE
T1ME
Stormwater (#1, Grab)
4
CLASSIFICATION!
W ATM AST'EW {tJ}M}
DRWIONG WATER
❑ SOUD WASTE SECTION
Stormwater (#2, Grab)
� �i�
�.34
4
`
}.
iMt
Stormwater 03, Grab)
�.ta [ i�
g . �O
4
Stormivater (It4, Grab)
T
`jL+
4`:
Stormwater (pS, Grab)
'
4
u�
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING IPMENTIDELIVERY
Y N
SAMPLES OOt1ECT O W
(fie pft)
. (p
SAMPLES RECENED IN LAB Ai_� °C
B G.) (SAMPLER}
DAT51IME
RECEMM B (S .}
'
COMMENTS:
BY (StG.)
DATEMME
RECENED BY G.)
DATEMME
RELINQUISHED BY (SSG.)
DATEMME
RECEIVED BY (SIG,)
DATFJ1Ti41
PLEASE 13EAC
Sampler must place a V for composite sample or a V for N 0 3 410 0 8
instructions for completing this form an the reverse side. Grab earn in in the blocks above for each rameter nested
Fofl�l a5 p � �

��
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
M01,11 r • I r J rrr . • . _ - - - «Li.�rl�Yn r�.LYI.Y I r/rl,'1
Permit No.: NGI
: Coverage o_: N/GG/ OI (a/ 0
Facility Name/�1r 1 18
Cw4jg6 AAA at fit__ sS
County: �.t'OfinF-�LF Phone Nb. c S ;4- / gPtYd
Inspector. -A,
Date of Inspection: (.
Time of inspection: 7' 3y Aayl
Total Event Precipitation (inches): . , 3 a
Was this a Representative Storm Event? (See information below) ® Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signare, I certify that this report is accurate and complete to the best of my kmowledge:
of Permittee or
1. Outfall Description:
Outfall No.. - ! Structure (pipe, ditch, etc.)
Receiving Stream: Pkue AL
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, wear
chlorine odor, etc.): MINI -
F�)A cY
Page 1 of 2
SWU-242-20120613

A Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 (2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 © 3 4 5
7. Is there any foam in the stonnwater discharge?
Yes
S. Is there an oil sheen in the stormwater discharge?
Yes
9. Is there evidence of erosion or deposition at the outfall?
Yes
10. Other Obvious Indicators of Stormwater Pollution:
A
List and describe _, QA)e _
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
5wU-242-20120613

An �kt�
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
� r f r � • :.�i[�r+.rWailJYW/ ' :kill: •w�i.l.�n�1�[•l FJC7�1 �7�4.1• �� 1 � 1 ' t
Permit No.: N/C/ I I I II 1 I r Certificate of Coverage No. NIGGI-QI(0i0111 l�l
Facility Name: -�
County:"hilea-Phone
No- a a
Inspector:
Date of Inspection:
Time of Inspection: _ 7 36 A. -A
Total Event Precipitation (inches): 3
Was this a Representative Storm Event? (See information below) P Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event' is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
of Permittee or
1. Outfall Description:
Outfall No. a - Struc (pipe, ditch, etc.)
Receiving Stream:74 d
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): _ _ NO AhC_--
Page 1 of 2
SVM-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 (D 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:-
1 3 4 5
7. Is there any foam in the stormwater discharge?
S. Is there an oil sheen in the stormwater discharge?
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Yes
Yes
Yes
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosionideposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
SWU-242-20120613

A
i!CLDEfN—RR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NIC!
Facility Name: I
County:
Inspecta.
Date of k
Time of Inspection
Total Event Precipitation (inches):
r .3a`
Coverage
Was this a Representative Storm. Event? (See information below) [2 Yes ❑ No
'a/
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event4na ,C,ntain up to 10 consecutive hours of no precipitation.
By this sign"re, I certify that this report is accurate3pd complete to the best of my knowledge:
of Permittee or Designee)
1. Outfall Description:
Outfall No. Stru ipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): a,AJ 6
I
Page 1 of 2
SWU-242-201206I3

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
I 6 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 © 3 4 5
b. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 D 3 4 5
7. Is there any foam in the stormwater discharge? Yeso
S. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
c
10. Other Obvious indicators of Stormwater Pollution:
List and describe Mej - - - _
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
SWU-242-20120613

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
r Y►.y r�l�: � . �
Permit No.. NICI I I I / I I / r Certificate of Coverage No : N/ G/ /J�J b/ll
Facility Name: al
County: Phonen.l c
Inspector:
Date of Inspection:
Time of inspection: 7' 3a
Total Event Precipitation (inches): 3 A
Was this a Representative Storm Event? (See information below) �A Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signatur94 certify that this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
1. Outfali D ripdon:
OutfalI No. Struc (pipe, ditch, etc.)
Receiving Stream: TG a X ��
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors: —
3. Odor: Describe any
chlorine odor, etc.): T
using basic colors (red, brawn, blue, etc.) and tint
inct odors that the discharge may have (i.e., smells strongly of oil, weak
S)ArU-242-20120613
Page 1 of 2

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 0 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 © 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 O 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious indicators of Stormwater Pollution:
List and describe _ kd
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
SWU-242-20120613

a 7-A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For Puidance on llin out this o
Permit No.: N/C/
Facility Name:
County:
Inspector:
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches):
.3A
of Coverase No.:
Was this a Representative Storm Event? (See information below) A Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event mny r, miain up to 10 consecutive hours of no precipitation.
By this signa43re, I certify that this report is accurate Od complete to the best of my knowledge:
of Permittee or Designee)
1. Outfall Description:
Outfall No. _ S Stru (pipe, ditch, etc.) -- Rae
- _ T
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: - 44 g
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
lk
Page t of 2
SWU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 (0 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
I AN 3 4 5
ti
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 6) 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes Ido)
10. Other Obvious Indicators of Stormwater Pollution:
List and describe A k Ak --
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
SWU-242-20120613

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCGO60000
CERTIFICATE OF COVERAGE NO•'NC 6 d 1 O JAN � 9 z0,AMPLE COLLECTION YEAR aZ0 i 7
FACILITY NAME ACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY DWR SECTIOs,i ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLE NG SAMPLES l�"FORMA ESSIi�$¢�#ARGING TO SALTWATERS? [:]YES ®NO
LABORATQRY Q Lab Cert. #
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall z s.?3 or No discharge this Period
Outiafl Nb'` .,
L'
;Saris ler[oilected:
r P _.i'S...c�.:�r�iLr-
r
W
�~ ' T55 ,'"
_ m !
;'` H
P '.
`Standard units ¢
$,COQ
i Kt
�'R, .1
` m ! ,:
' oil;and'Grease • -
}1,;.,�ar..,,tr,ti-.:...�.
rh ! . S _ ,,,
' Fecal`Colfform•"
r. ,'
[f"
,Colonies er�lOp,ml,�;
;Enteroonct
�t �-
��7+,_ ;
3r, CaIoni$s, er:l0p,ml�f ,
T ' S.
3 wvr
Y'
•["
f ir, F i:i'
f i.
-�' •"30`
W�1000 •
.t,. `50d�, �,.
-L
C .9
6
A
J*- .- 4— ,
/
2//'6f6
<
dAll
.4
/ 17
< Q'W
1 only —applies to facilities that use/process meats. `
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per months ❑yes � no (ifyes, complete Part 8)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 5S gal of new motor Oil/month.
DiitfwI No:f'v;
--?i''. � •• °.- qL'��.'
:'� •
M' Sample Collected
A..-'.iE�3 vi "�,_ 'l'�. h
.,a
_ ' mo/cJd/ �ti�s.�t�
OI[ ndrGrease
.J� ('La...q Jam- -. ...' q
"" a it % S4'R+'
�,. m L
5 -e .-.L_"'2 a .jh
yr Rim L 3 ;,,,c
i .rj f% Si
pH,
"s-ol- .�"�Y•.-"'..-;
Standard:units 4
New Moor Oil•Usage yu
r.' �SY:'•'.`.�.' .: - L.� C.
T r� /� s .�
�Mnual ave I' mo
Benchmark
_
-
30
100 ar 50: '
6A = 9b
Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still:submit this discharge monitoring report with a checkmark here.
4See General Permit.text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012

*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 it 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 on final and one copy of this DMR Including all "No Discharge" reports, within 30 days o recei Uo the lab results or at end o
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN• THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision,in-accordance with a
system designed -to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of;my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
re of Peimitti
- jl-)?
(Date)
Additional copies of this form may be downloaded at: http:jjportaLncdenr.org/weVwq/wsZsu/npdessw#tab-4
wq/wsZsu/npdessw#tab-4
SWU-249
Last Revised: October 18, 2012
pa vr. '7 of 7

Emohnng[W % dmc
nn f?AOor-nq
r.U. UUA IV00, 114 VAIVVIUNI Ur-1VC _- ",',,' 1-riviVC (Zoe) too-OZUB
GREENVlLLE, N.C: 27835-7085 FAX 2_52),756-0633
ID#: 449 D
HILLSHIRE BRANDS
ATTN: MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD
TARBORO ,NC 27886
DATE COLLECTED: 12/06/17
DATE REPORTED : 12/13/17
REVIEWED BY:
Stormwater
Stormwater
Stormwater
Stormwater
Stormwater
Analysis
Method
PARAMETERS
(#1, Grab)
02, Grab)
(#3, Grab)
04, Grab)
(#5, Grab)
Date Analyst
Code
BOD, mg/l
11
11
3.2
<2.0
2.1
12/07/17 KMR
52109-11
COD, mg/1
30
31
28
<20
<20
12/11/17 SEJ
H8000-79
Total Suspended Residue, mg/l
4.5
6.2
<2.8
<2.7
<2.6
12/08/17 AKS
254OD-11
Oil & Grease (HEM), mg/l
<5
<5
<5
<5
<5
12/12/17 SEJ
1664E

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr. Page I of _ 1
Greenville. NC 27858
envirogmentl igc.com
DISINFECTION
GHLORINENEUTRAtJZEDATCOLLECTlON
Phone [phone] •Fax [phone]
Ij CIiLORINE
CLIENT: 449 D Week: 32
UV
L1.
C/_'
pH CHECK (LAB)
HILLSHIRE BRANDS
NONE
p
p I
p I
G
CONTAINER TYPE, PIG
ATTN. MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD
CHEMICAL PRESERVATION
TARBORO NC 27886
E o
A - NONE D - NAOH
[phone]
w U
?
9
o2
V3
w
� B - HNO, E - HCL
= F
aLU
g
w C H,SO, F ZINC ACETATE/NAOH
COLLECTION
F
8
O
A
G NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
CL4SSIFlCATION:
WASTEWATER (NPDES)
❑ DRINKING WATER
sow
?
r::¢
n:
>na:
r�_`/J %%/�.
�j]
,
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING IPMENT/DELIVERY
`:1 N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT�°C
RaINQUISHED BY SIG.) (SAMPLER)
DATEITIME
RECEIVE IG.)
ATEMME
COMMENTS:
IRELINOUISAED
_
BY (SIG.)
DATEMME
RECEIVED BY (V
DATEMME
RELINQUISHED BY (SIG,)
DATEMME
RECEIVED BY (SIG.)
DATEMME
PLEASE READ Instructions for completing this form on the reverse side, Sampler must place a "C" for composite sample or a "G" for N U 3 3 3 8 't 8
FORM #5 Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the tab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 mt. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted & --Z A - A0 RECEIVED
CERTIFICATE OF COVERAG NO. NCG06 01 `
FACILITY NAME 1XIkk.4,r
COUNTY
PERSON COLLECTfNG SAMPLES T 7"p'
LABORATORY �&_ dJAQ Jrn Lab Cert. # Y'E D
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _ -26 / 7
JUN 15 2017
FACILITY ACTIVITIES INCLUDE (check all that apply): CENTRAL FILES
❑ use/process meats ❑ use animal fats/byproeWR SECTION
DISCHARGING TO SALTWATERS? ❑YES NNO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total. event rainfall Z or ❑ No discharge this period'
Outfall No
'Sample�t -id, 7
� `TSS,
"` H;.
'P` Es
,Standard°units
_�.
?COS;.
��:,,�s� �.
moil and',Grease,Y .-
�.� ,'�1,«<<n
,L *
` ".Fecal'Ccllfo�rri
>�s.a,r,�.-�i1� �4,
tiP; Colonies er;l00,mh.
xmr�r , m,�,•,,
a ; Cplonles; r4100,m! se
9enchmark`
!Yt 1.7#�,.
f; "� ax ..}t0'i�
y -
,�100 oFW41
�, RC
"',W thin 6,Q—.9?Of•
t
; ' - 120,
1'f'„.�r�'i •�( `f j'ti"r iT'�%f
j 30
..•'f V, _,. f}••"J• h
1000 ,
Y •'- t - 4.
3
S 3—
S
—ffi
<a9, to.3-
5'-9
12,
1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
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 > SS gal of new motor oil/month.
Outfall Nii:I"
�;tiSampierCollected, `
�YOII and'Grea�se ' i
"�} =k TSS,
��$'' ix .
'k'ini Li;,z.x
pH, 5"
.6tn S,+ti•" '.3L� ^`':T"^'.f
Standartlsunitsn=
-NeW Motor Olfusage,
^!'. "".jii h1::.'d.':1 r n §r%
y�tiMituaifavera a i/lino,-,
Benchmark
30
- 10o ii b0•
64= 9.0"
Only applies to facilities that use/process meats.
Z The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at 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.
(ifye
s complete Part B)
SWU-249 Last Revised: October 18, 20I2

*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
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cookof this DMR, includina all "No Discharae" reports, within 30 days of recei to the lob results for at end of
monitoring period in the case o "No Discharge" woos 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."
a15�
(Signature of Perm
(Date)
Additional copies of this form may be downloaded at: http://i)ortal.ncdenr.org/web/wgZws/sulnpdes5w#tab-4
S WU-249
Last Revised: October 19, 2012
Pacre I of ?

EmAmMUM % hwoo mmud
P.O. BOX 7Q85, .114 OAKMONT DRIVE PHONE (252) 756-
GREENVILLE. N.C. 27835-7085 FAX (252) 756-
ID#: 449 D
HILLSHIRE BRANDS
ATTN: MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD DATE COLLECTED: 05/23/17
TARBORO ,NC 27886 DATE REPORTED : 05/30/17
REVIEWED BY:
PARAMETERS
BOD, mgll
COD, mg/1
Total Suspended Residue, mg/1
Oil & Grease (HEM), mg/1
,;
Stormwater
Stormwater
Stormwater
Stormwater
Stormwater
Analysis
Method
(#1, Grab)
(#2, Grab)
(#3, Grab)
(#4, Grab)
(#5, Grab)
Date
Analyst
Code
3.4
2.3
3.9
<2.0
<2.0
05/23/17
KDS
521OB-01
35
36
36
25
25
05/23/17
SEJ
H8000-79
11
9.3
3.9
<2.6
<2.8
05/24/17
KKM
254OD-97
<5
<5
<5
<5
<5
05/25/17
SET
1664E

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. $ox 7085, 114 Oakmont Dr. Page I of 1
Greenville, NC. 27858
environment) inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
Ij CHLORINE
CLIENT: 449 D Week: 6
UV
7-1
rL
pH CHECK (LAB)
HILLSHIRE BRANDS
❑ NONE
P
P
P
G
CONTAINER TYPE, PIG
ATTN- MR. JOHN H. CHAPMAN, JR.
CHEMICAL PRESERVATION
110 SARA LEE ROAD
❑
TARBORO NC 27886
A
C
A
C
A - NONE D - NAOH
E U
[phone]
L
�
B- HNO, E- HCL
0 0
o
_
LU C - HZ50, F ZINC ACETATE/NAOH
COLLECTION
F a
°° o¢
wa
S
U2
q
o
0
U
a
F
O
¢ G-NATHIOSULFATE
�
a
SAMPLE LOCATION
DATE
TIME
Stormwater (#I, Grab)
4
CLASSIFICATION:
❑ WASTEWATER (NPDES)
Stormwater (#2, Grab)
7 tS
M
4
: ;
`??
W,
Stormwater (#3, Grab)
4
?
DRINKINGWATER
is
.�
Stormwater (#4, Grab)
+� 7
4
DWOIGW
i�
Stormwater (#5, Grab)
0�3
4
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING IPMENTIDELIVERY
N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT °C
REL1 ISHE ) (SAMPLER)
TEIII,
)AAJErs7bV
BY ( )
;
ATEITIME
111
COMMENTS:
_yzz�qn
RELINQUISHED BY (SIG.)
DATEMME
RECEIVED B SI . /
DATE/TIME
RELINQUISHED BY (SIG.)
DATEITIME
RECEIVED BY (SIG.)
DATEIi1ME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C° for composite sample or a "G for N o 328862
FORM #5 Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
r
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 ml. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collectiod' on the front of this form for any sample locations applicable, This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quallit`, General Permit No. NCG060000
Date submitted
CERTIFICATE OF
FACILITY NAME
COUNTY 4Z
PERSON COLLEC
LABORATORY —A
I
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR �6 / (a
FACILITY ACTIVITIES INCLUDE (check all that apply):
E] use/process meats []use animal fats/byproducts
VBQCHARGING TO SALTWATERS? [:]YES NNO
200 0 " PLEASE REMEMBER TO SIGN ON THE REVERSE
CENTRAL FILES DWR SECTION Total event rainfall
2# a r Na discharge this period'
butfaffNd.'
rnii/da/?�V
@4
iia'nip'VrdtiUn
"t6b, ' Z-
. ..41
.1 �� M
F 'I' Co M"­�
-Of
nlesger,100,
'100'a,
r
%ffithiff,6.0
•I
30.
?
CP
t<.2.9-
(e
At JA
AiM
Sep
-0c
I j
<_d2a
-
-<T
I - - -
Only applies to facilities that use/process meats.
2 The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than SS gallons of new motor oil per month? [] yes Dg no
Part 8: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
ix,
TS5,
pH"' -
New
30 L.n_n!u NkNr_Aa ji�,
Benchmark
­30
ioMor Sif
C'01-:4
A
' Only applies to facilities that use/process meats.
2 The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still4ubmit this discharge monitoring report with a checkmark here.
4 See General Permit text, Table 3, identifying the especially' sensitive receiving water classifications where the more protective benchmark applies.
(if yu, complete Part B)
SWU-249 Last Revised: October 18, 2012

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR; includina all "No Discharge" reports, within 30 days of receipt of the_ lab results &or at end of
monitorina period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQCentral 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: htt ://portal.ncdenr.org/web/wq/­ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18, 20I2
1 PatrP I of

EmAnNOMW % hm
mmUd
HILLSHIRE BRANDS
ATTN: MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD
TARBORO ,NC 27886
ID#: 449 D
DATE COLLECTED: 12/05/16
DATE REPORTED : 12/14/16
REVIEWED BY:
Stormwater
Stormwater
Stormwater
Stormwater
Stormwater
Analysis
Method
PARAMETERS
(#1, Grab)
(#2, Grab)
(#3, Grab)
(#4, Grab)
05, Grab)
Date
Analyst
Code
BOD, mg/l
<2.0
3.6
3.3
2.9
<2.0
12/06/16
SDB
521OB-01
COD, mg/l
34
26
33
<20
<20
12/07/16
SET
H8000-79
Total Suspended Residue, mg/l
<2.7
<2.9
5.7
4.9
<2.8
12/07/16
KDS
2540D-97
08 & Grease (HENO, mg/l
<5
<5
<5
<5
<5
12/07/16
SEJ
1664B

Environment I, Inc. CHAIN OF CUSTODY RECORD
P.O. Box-7085, 114 Oakmont Dr. Page _L of 1
CMS,,,viIle. NC" ..7RSR
environment 1 inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
1
CHLORINE
CLIENT: 449 D Week: 32
pH CHECK (LAB)
UV
P
P
P
G
CONTAINERTYPE, PIG
HILLSHIRE BRANDS
❑ NONE
ATTN: MR. JOHN H. CHAPMAN, JR.
CHEMICAL PRESERVATION
110 SARA LEE ROAD
❑
TARBORO NC 27886
A
C
A
C
A - NONE D - NAOH
o
[phone]
`
LU
B - HNO, E - HCL
0 o
Z
cc
C - HZSO, F - ZINC ACETATEINAOH
COLLECTION
a
o
¢
8
G
p
+�
A
OU
F4
F
C7
O
¢ G-NATHIOSULFATE
rc
a
SAMPLE LOCATION
DATE
TIME
Stormwater (#1, Grab)
//
[O• `5
4
:fi^:ki
:a
CLASSIFICATION:
❑ WASTEWATER(NPDES)
DRINKINGWATER
Stormwater (#2, Grab)
5 /
4.45
4
Stormwater (#3 Grab)
4
L.
two:
1a
LX1`
,5
'
k
Stormwater (#4, Grab)
h
4
7
SOLID WASTE SECTION
Stormwater (#5, Grab)
S /
(p ,'
4
L �.
K'm
..
Y
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB A , °C
RELIN SHEDBY . (SAMPLER)
VATU N
RECEIVED SI .)
ME
COMMENTS:
RELINQUISHED BY (SIG.)
DATEIIIME
RECEIVED B G.)/
DATElfME
RELINQUISHED BY (SIG.)
DATElnME
RECEIVED BY (SIG.)
DATEMME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a"C" for composite sample or a "G" for N ° 319108
FORM #5 Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed or any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State netting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to (lie lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements ofthe regulation if (here
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of40 ml_ Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this firm.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "C" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name ofperson or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disintection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSI DERATIONS:
Colifbrm and Enterococci samples have a holding time of-6 hours from time ofcollection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling; the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

A
,fijJFL
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: ht :ll ortal.ncdenr.ortr web/wo/ws/su/nRdessw#tab4
Permit No.: N/CI I I I 1-1 I_I or Certificate of Coverage No.: N/C/G/ 0/ 6Y O/ 1I (o1.&I
' A LS
Facility Name: + [ ;St , SA-+P0tn oC- trtiii{�__
County: _ de Phone Nd a'k •
Inspector: d
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches):
+7g
Was this a Representative Storm Event? (See information below) 53 Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By th atur(e�, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee 61 Designee)
1. Outfall Description:
Outfall No. 1 Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: , 14
2. Color: Describe the color of the
(light, medium, dark) as descriptors: C
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
Page 1 of 2
SWU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where l is clear
and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
V 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWLJ-242-20120613

fix'A
A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: hqp://portal.ncdenr.ofgtweb/wa/ws/su/npdessw#tab-4
Permit No.: N/G_
Facility Name:
County:
Inspector:
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): _ ! ? 1 .
Was this a Representative Storm Event? (See information below) Pd Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this suture, I certify that this report is accurate and complete to the best of my knowledge:
• rr _ i.L
(Signature of PermittJ or Designee)
1. Outfall Description:
Outfall No. a Structu (pipe, ditch, etc.) �" _
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using
(light, medium, dark) as descriptors:
3. Odor: Describe
chlorine odor, etc.):
(red, brown, blue, etc.) and tint
distinct odors that the discharge may have (i.e., smells strongly of oil, weak
sWU-242-20120613
Page 1 of 2

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
Q 2 3 -4 5
7. Is there any foam in the stormwater discharge? YesL:J
S. Is there an oil sheen in the stormwater discharge? Yeso
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
!
List and describe O7&!y Ge"qW
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-20120613

A7j,Ot*O)A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: btipT//p_orW.ncdenr.org/web/wq/ws/su/npdessw#tab-4
Permit No.: N/C/ l I / /—/ / 9r Certific tt
Facility Name:
County: Phone
Inspector: w
Date of Inspection: i /
Time of Inspection: �%; is—►�^
Total Event Precipitation (inches):
Coverage No//•,� NIC/GIOlk
Was this a Representative Storm Event? (See information below) � Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this,4ignature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Pernuttbe or Designee)
1. Outfall Description:
Outfall No. 3 S cture (pipe, ditch, etc.) _ 2ia
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge i
(light, medium, dark) as descriptors:
basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor,
Page 1 of 2
swU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
l (0 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
1 eo 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy;
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes G
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-20120613

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: htty://portal.ncdenr.or,-m-/web/wq/ws/su/npdessw#tab4
Permit No.: NICI—I
Facility Name:
County:
Inspector:
Date of Inspection:
Time of Inspection:
•
-
Total Event Precipitation (inches): 17.JP
No.: NICIGIOI&161,
Phone No.. V4Z i 6t~/.1/—
Was this a Representative Stone Event? (See information below) �4 Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this mature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permitteebr Designee)
1. Outfall Description:
Outfall No. _ Structure (pipe, ditch, etc.) i2fpf
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
using basic colors (Fed, brown, blue, etc.) and tint
3. Odor: Describe XV,-_J,4
distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc_):
Page 1 of 2
sWU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 ID 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
1 d) 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5- is extremely muddy:
1 3 4 5
7. Is there any foam in the stormwater discharge? Yes
S. is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes 0
10. Other Obvious Indicators of Stormwater Pollution:
List and describe _ 40 �F
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
SWU-242-20120613

1
A.`J60A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http://portal.ncdenr.or!-!/web/wg/ws/su/n.pdessw#tab-4
Permit No.: NICI_
Facility Nam
County:
_zEdfInspector: --t6t.
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): • 7 p
Was this a Representative Storm Event? (See information below) 'IX Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By thi^gnature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of PerrAttee or Designee)
1. Outfall Description:
Outfall No. ,-5- Structure (pipe, ditch, etc.)
Receiving Stream: 1�
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge
(light, medium, dark) as descriptors:
basic colprs (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): /)%nA!�
Page 1 of 2
5WU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where t is clear
and 5 is very cloudy:
l0 2 3 4 5 '
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
fl 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremeiy muddy:
2 3 4 -5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes �c
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Storm Pollution:
List and describe �D 1�/ ,
Note: Low clarity, high solids, and/or the presence of foam, on sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. _
Page 2 of 2
SWU-242-20120613

:= SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 16 • Q— / k
0
CERTIFICATE OF COVERAGE NQ, NCG06Q I _� SAMPLE COLLECTION YEAR 0201
FACILITY NAME FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ❑ use/process meats ❑ use animal fats/byproducts
LABORATORYECTNG SAMPLES Lab Cert. � R�����TO SALTWATERS? DYES �NO
PERSON JUN 13 MASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
�Q
rFKITRAI 1:11 jiqtal.event rainfall 2 �$ or ❑ No discharge this period'
•`Outfall Na:
_ a k
;'Sairipie`CollecCed
. i {{"
" ,`T55;
" 'z! °'k
` , }pH, '
" a •-f!Y4
Stantlard units
xcoWR,
[#7fk':;"'
"ak-�9;N� �1
:m L. .,
EQ�ilfaildiGrease; ,-
:et;•;Ye...J.r:a
gym ,L',r �.
+ , F,eca) �Cofiforni'J'
i.4:, II r, v rF;,!
"kix
Calonles; ra0o:MlAj
Enferococcly =«
`ar �.-,gi vuayuYul+c.+F `. a.[r '•a
i -
,.,;CPlonies, r 100;m1
Be#icliiriark ;ti#
» �;• _, ,' ��*� . i .hai
?100-or 50 :K
Within6 0-s.a
:120
30.
't0oa
'S00f E-,; .
Sao+
S
N
- 17 - U.
%020
Al Z�0*
c
c, ao
<
n
-7 '
< s
At
-
-36
< Q14
L 9n�
t]nly applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications.where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes O? no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
OutfaN'N&% YR
.
SampleiCollected; "�
m
, OII`and'Grease,
� T55,
pH;
St ndard�units
�New;MotorOlI0We, '-
rM al aver ems/ ot.`.
Benchmark
30
100 iWS
6:0•= 9.0
Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain.gauge.
'For sampling periods with no discharge at any outfalls, you must stillaubmit 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 M complete Part B)
SWU-249 Last Revised: October 18, 2012

*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 Dj
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copy of this DMR; including all "No Discharge" reports, within 30 days of receipt,of the lab results for at end o
monitoring period In the case o "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS•CERTIFICATION, FOR ANY'INFORMATION-REPORTED:
"I certify, under penalty of law, that this document -and all attachments were.prepa-red under my direction or supervision,in accordance with a
system designed to assure that qualified personnel properly gather a`nd evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of:my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of P4ittee)
(Date)
Additional copies of this form may be downloaded at: htttp://aortal.nc,denr.ora/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
PA op. 7 of

A=AIL iN�
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: hitp://nortaLncdenr.orWweb/wcL/ws/su/npdessw#tabA
Permit No.: NICI_I I I I_I I / or Certificate of Coverage No.: NICIG/ DI &101 / 1(I g?I
Facility Name: i I iS ltQ4?{�Amtjs
County: z Phone No. - -
Inspector: C
Date of Inspection: - I -7' l
Time of Inspection: Y. 30 /OM
Total Event Precipitation (inches):
.(�13 . RECEIVED
Was this a Representative Storm Event? (See information below) CR Yes ❑ No JUN 13 616
CE�N1 TR�AL{�FILES
Please check your permit to verify if Qualitative Monitoring must be performed during a'repP'e'r'ATJM
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this sign, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or LVsignee)
1. Outfall Description:
Outfall No. I S cture (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors: t
using basic colors (red, brown, blue, etc.) and tint
I Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): BA)
N
Page 1 of 2
5WU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
`r 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
© 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
I (D 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes Nd
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe Ali) tj
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
SWU-242-20120613

AI;AIV
HCDEHR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit.- http://RorL-d.ncdenr.ora web/wg/ws/su/ni2dessw#tab-4
Permit No.: N/C/
Facility Name: _
County: ��
Inspector:
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): ' �?
of Coverage No.: NICIG1016101 / �I
Was this a Representative Storm Event? (See information below)
SUN130M
LES
CENTi- F tiON
o'?es 3No
Please check your permit to verify if Qualitative Monitoring must he performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this sign, I certify that this report is accurate and complete to the best of my knowledge:
f\ _ , --)
(Signature of Permittee or
1. Ouifall nption:
Outfall No. Structure (pipe, ditch, etc.) CD jyc1j
Receiving Stream:
Describe the irkdustrW activities that occur within the outfall drainage area: 6
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe a distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): G
Page I of 2
SWl f-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
b. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
l.% 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes ©o
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe /V d N45-
Note: Law clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
5WU-242-20120613

CERTIFICATE OF G
FACILITY NAME
COUNTY
PERSON COLLECTI
LABORATORY Z
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000�1�
Date submitted
:RAGE NO, NCG06 2 f2 g SAMPLE COLLECTION YEAR o20! S JAR $ 2016
CEIvr
I s
FACILITY ACTIVITIES INCLUDE (check all that apply): L #jLed
�Gt �fl4 b& _ t i - ❑use/process meats ❑use animal fats/byproducts
_AL
SAMPLES . ern! �L� . Cr �411ivt -iyj -1f' DISCHARGING TO SALTWATERS? [:]YES�NO
A0fAEAJ2 Lab Cert. # l0 _
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
T'otal.event rainfall Z or No discharge this period'
Outfall,Na:
t, . }
Saml le:Collected'
,!
r r. ;iito/dd/ r T_
"TSS !.
^m L
�, �.'H5
*P !
Standard units ;
°GOD
i /
., m L 4
Oil and!Grease; x.
%•cI7j;^,,.{�p•c
- m .L .t;
�y/.Fecal'Colifor`nr';�;
j .(_;37t
.Colonlei pr_100;m1�_+
r„ ;' a;Enterococcl„
,,S�f1,'i�- ..'.5 {;'Fv1, 2
�, Cpionies; er,l0a;m1 �
tdenchmark" Y
S1 f
3 f _ r�"�.± x100
.r w
or'SO:`
7` F:
. Witlliln°.6A'=90
$� ..i�;•'�'_ t _:.�
120
y. s•i"-' �. t E-
'3D.'
�,�r.: ,r•�" h `i, r•re
1000
74.= ti
,y
a 7 i
9
<
t
N a•
N p
a
3
d
C 5
N 14
62 r
C
N
Nsq
. S
-U
C S
I #V
' Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes Nno
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall Nil }a
�,t
j ,
`#�Sarr�pieiGollected;
17 •� ...%�rr,
�� s'zmo�dd/, r�1,
�'O11,and Greaie; F
,tk
_,m L
'
sr+ TSS,
PH. '
ra+�-��:...r•�i,'7'
Standard�units
,New''Motor..Oli wigq;' ,.
.-.t c�,!.�,�
_ nnual�aver eigal/inatF`�
Benchrr►ark '
�
3�,.
100'a SQ,
6.04 9.0x
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 outfalis,'you must still submit this discharge monitoring report with a checkmark-here.
°See General iPermit.text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
ice complete Part B)
SWU-249 Last Revised: October 18, 2012

*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;K
1F YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cove of this DMR, includina all "No Discharge" reports within 30 days of receiat,o fthe_lob results for at end o
monitoring period in the case of "No Discharge" Meortsl to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
ti
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 gaiher'and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of>my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee
� J
(Date)
Additional copies of this form maybe downloaded at: httv:/Lportal.ncdenr.or-g/web/wQ/ws/su/nPdessw#tab-4
v
S W LI--249
Last Revised: October 18, 2012
Pa yr 1 of l

A
NCDENR
Stormwater Discharge OutfaR (SDO)
Qualitative Monitoring Report -
For guidance on filling out this form, please visit: http://portal.ncdenr.oroweb/wg/ws/su/npdessw#tab-4
Permit q� Certificate of Coverage No_: NfIGlolkl dl /I-A61
Facility Name:
County:
Inspector:
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): " 42
Was this a Representative Storm Event? (See information below) 0 Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation_
By this sign re,fI�certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or%esignee)
1. Outfall Description:
Outfall No. _ ._` Struc re (pipe, ditch, etc.) �I: _
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): No pd6e,
Page 1 of 2
SN U-242.20120613

4, Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
O 2 3 4 5
6. Suspended Solids: Choose -the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 0 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
S WU-242-20120613

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http:llportal.ncdenr.orglweblwglws/su/npdessw#tab-4
Permit No.: NICI 1 I 1 1 I 1_I or Certificate of Coverage No.: ClG/ ' 610/ 1l
Facility Name: C%J
County: Phone No.
Inspector:
Date of inspection: AZ
Time of Inspection: 02 : / Iri
Total Event Precipitation (inches): a 109
Was this a Representative Storm Event? (See information below) CR Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I
t this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Ontfall Description: ,
Outfall No. C�2 Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
I Odor: Describe any distinct
chlorine odor, etc.):
using basic co ors (red, brown, blue, etc.) and tint
that the discharge may have (i.e., smells strongly of oil, weak
SWU-242-20120613
Page 1 of 2

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
©` 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
b. Suspended Solids: Choose- the number which best describes the amount bf suspended solids in
the stormwater discharge, where I is no solids and 5 is- extremely muddy-
1 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes �1
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
5WU-242-20120613

AWKWA
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this farm, please visit: hup://portal.ncdeiir.orgweb/wg/ws/su/npdessw#tab-4
Permit No.: NICI_
Facility Name: -j
County:
Inspector:
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): 10_Y
Was this a Representative Storm Event? (See information below) X Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
M
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify thahis report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. -� Structure (pipe, ditch, etc.) eLl�1'1
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors: ---,
3. Odor: Describe
chlorine odor, etc.):
using basic lors (red, brown, blue, etc.) and tint
siZ -
distinct odors that the discharge may have (i.e., smells strongly of oil, weak
SWU-242-20120613
Page 1 of 2

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
4 0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely -muddy:
1 3 4. 5
7. Is there any foam in the stormwater discharge? Yes Q
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe M eh
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-20120613

A��
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: htM.//portal.ncdcur.orglweblwo/ws/su/nDdessw#tab-4
Permit No.: NICI_I
Facility Name: 1i
County:
Inspector: �t
Date of Inspection: _
Time of Inspection:
Total Event Precipitation (inches): 4102
Was this a Representative Storm Event? (See information below) N Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative. Sto rm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in whichno storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify that s report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee).
1. Outfall Description: -1, L
Outfall No. �` Struc (pipe, ditch, etc.)
Receiving Stream:
Describe tir industrjal activities that oc 1
2. Color: Describe the color of the
(light, medium, dark) as descriptors: _ _ A
3. Odor: Describe any distinct
chlorine odor, etc.):
the optfall drainage area:
basic colors (red, brown, blue, etc.) and tint
7 . n Ac aal
that the discharge may have (i.e., smells strongly of oil, weak
SWU-242-20120613
Page 1 of 2

4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
V 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids-
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 3 4 5
7. Is there any foam in the stormwater discharge?
S. Is there an oil sheen in the stormwater discharge?
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators m s of Storwater Pollution:
List and describe A) d *t)4A,r5 6K kSs
Yes
Yes
Yes o
r
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-20120613

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on falling out this form, please visit: htrp://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
Permit No.: NICI
Facility Name -
County:
Inspect0
Date of 1
Time of
or .Certificate of Coverage No.: NICIQ/OI (d
Total Event Precipitation (inches): • ("L, 2
Was this a Representative Storm Event? (See information below) ;9 Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify thatAbis report is accurate and complete to the best of my knowledge:
0, c I — (� -, - -), - I - . - . ,
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No.�
Receiving Stream:
Describe the industrial activit
(pipe, ditch, etc.)( _
that occur within the outfall drainage area:
2. Color: Describe the color of the discharge
(light, medium, dark) as descriptors:
3. Odor: Describe
chlorine odor, etc.):
basic colors (red, brown, blue, etc.) and tint
R, eA
distinct odprs that the discharge may have (i.e., smells strongly of oil, weak
f Q dam.
SWU-242-20120613
Page 1 of 2

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
�j 2 3 4 5
6. Suspended`Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there'an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe I110 j!554r"5
'
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2of2
5 WU-242-20120613

Tarboro Bakery
SWPPP (February 2003)
Annual Comprehensive Storm Water Inspection Checklist
X. EVALUATION OF MATERIAL HANDLING AND STORAGE AREAS FOR POTENTIAL SOURCES OF
STORM WATER CONTAMINATION: (USE MONTHLY INSPECTION LIST AND ADD NOTES BELOW)
jell fi �}5 1AXee t-d &1cVA me.," ' wAn i0o -�r. ) WO5.
2. OBSERVATIONS OF STRUCTURAL CONTROLS AND DETERMINATION OF PROPER OPERATION AND
APPROPRIATENESS:
RIl Awn" w6p6c+6d c-j"' Mo,)�k AP 16k"Ajq) c 1s
Iw p I� � oa-�•� pre,a ��
3. OBSERVATIONS OF STORM WATER DISCHARGE OUTFALLS TO ENSURE STRUCTURAL INTEGRITY
AND EVALUATE THE PRESENCE OF NON -STORM WATER FLOW:
AM 0
Pi�AC durCtNJc ` c.�P+4IL A�Nd CoK as w� r maac-.
4. ASSESSMENT OF IMPLEMENTATION OF SWPPP TO INCLUDE INSPECTIONS, SPILL EQUIPMENT,
CONTROL MEASURES, EFFECTIVENESS, ETC.
fill sill egk,p�+c�� ,s /Ij p� � �Nd II'9 sy�pl►�
41441 AA ce,4-Rb 1 n,,5-asuAOS AW ,,.) pACe_.
5. POSSIBLE CORRECTIVE MEASURES TO IMPROVE SWPPP IMPLEMENTATION. ALSO COMPLETE
REVISIONS LOG ON NEXT PAGE.
Signature of Plant

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SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality -General Permit No. NCG060000
Date submitted (.o " % l — % -!
CERTIFICATE OF COVERAGE NO. NCG06OLk f SAMPLE COLLECTION YEAR c2Q I
FACILITY NAM �� FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLE ING SAMPLESh J j2&2M DISCHARGING TO SALTWATERS? AYES NANO
LABORATORY EtVilla bCertA 10
PLEASE REMEMBER TO SIGN ON THE REVERSE -�
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall S l or ❑ No discharge this period3
OudallNo: '
w#'
Sam Ie`Collected `
v:virPS, .i4• Ht4�r�a's`r.l,
=;mfy/dd/�'tymI:„_t•..,::,i_Colonies:.pr10D:m1'1;Colonles;
x
"F's`:T55, �`'
w;
r r:+ ? fi,
?•?P*,�t`'` -;r�
COD,
, .r'
%, 011 and Grease; _
s ,,x,
� Fecal'Coiiforni ;` �,��
1,
,='Eriterococcl
r3I..a
er100�m1�a
.,Beni:hrfiark'. -'.•t
'" 's
+, � s = �t� , %�
t d
a10Q 0—FW4,
r +r 1
:INIt�i1V616,- 9 6
:�,s jf �.• NK, r
120
fir.i.. +a,7
30'
ad00 •
500�_ . ,
a�
o
D
<
Ila
�S
S, o
Only applies to racihties that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? E) yes PK no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 5S gal of new motor oil/month.$
Outfail No :"
/��'c w - 9r i ZT
'
�. ti �S .•�,>�}' �:�}
., ;,� mo/dd/ rra�►j'5�y;m
6 ndiGr
�. r. h'•w n ],A 2
L'rtr�t��s.m
7i '' TSS,
Leo
J J>wy >..L1i".S �YP 4�
i�C�Standard�units
u.... .� L.✓�� f !%•�.
�fNAnnival"avera e o
.BbrEchr6aitli
4
30
f00 orSO
6:0 — 9:0
A.,
CD
(if ves' complete Part B)
n
rn
Only applies to facilities that use/process meats.
zThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still.submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER ! REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME: '
Mail an original and one co o this DMR including
all "No Discharge" reports, within 30 days o recei t-o the lab results or at end o
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY.INFORMATION REPORTED:
"I certify, under penalty of law, that this document -and all attachrhents 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 informationsubmitted 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."
t-
(Signature of PermlVtee)
(Date)
Additional copies of this form may be downloaded at: http://Dortal.ncdenr.orp/webjwg/ws/sulnpdessw#tab-4
W
SWU-249
Last Revised: October 18, 2012
Pavp 7 of

FA
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: http:llportal.ncdenr.orOweb/wg/ws/su/nvdessw#tab-3
t .
. . et
Permit No.: N/C1 /
Facility Name:
County:
Inspector: _
Date of Inspection: _
Time of Inspection:
Total Event Precipitation (inches):
Was this a Representative Storm Event? (See information below) ❑ Yes 04 No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this sigrlae, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or
1. Outfall Description: 1
Outfall No. 15 Structure (pipe, ditch, etc.) tTcJl
Receiving Stream: j
Des�ibe ihq igdustrial activities that occur within the outfalt drainage area: - r-4-
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): "/%Z
Page 1 of 2
SWU-242-20120613

4: Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
3 1 6 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 6 3 4 5
6. Suspended Solids:. Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5,is" extremely muddy:
1 3 c4 L. S. +
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
A
List and describe / k4j
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosionldeposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
S WU-242-20120613

%A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http://Portal.ncdeor.org/web/wq/ws/su/nNessw#tab4
Permit No.: NICI I
Facility Name:
County: 90
Inspector:
Date of Inspection: _
Time of Inspection:
Total Event Precipitation (inches):
Was this a Representative Storm Event? (See information below) ❑ Yes ;@ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signatures certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Desig-*,e)
1. Outfall ription: 1
Outfall No. Structure pipe, ditch, etc.) �11 TU
Receiving Stream:
Desggbe the ipdustrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
Page l of 2
SWOT-242-20120613

4: Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 3 4 5
6. Suspended Solids: Choose the number which best describes the•amoun' of suspended solids in
the stormwater discharge, where 1 is no solids and,5 is extremely. muddy,:
12 3 4 5
7. Is there any foam in the stormwater discharge? Yes N�
8. Is there an oil sheen in the stormwater discharge? Yes N®
9. Is there evidence of erosion or deposition at the outfall? Yes U
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Y
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
he indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-20120613

A��jr�
NCDENR-
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: httpa/portal.ncdenr.orJweb/wghvs/su/npdessw#tab
Permit No.: NICI 1
Facility Name:
County
Inspector:
Date of Inspection: _
Time of Inspection:
Total Event Precipitation (inches):
891
Was this a Representative Storm Event? (See information below) ❑ Yes N No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
0
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signagire, I certify that this report is accurate and complete to the best of my knowledge:
(r`
(Signature of Permittee or Designee)
Z. Outfall Description:
Outfall No. 3 Struc (pipe, ditch, etc.) l
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the
(light, medium, dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): __ 0AJC-
Page 1 of 2
SWU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 �7 3 4 5
6. Suspended Solids: Choose the number which best describes the amountof suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy: '
1 3 4 5
7. Is there any foam in the stormwater discharge? Yes �N
S. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe kQoae�f
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
1
Page 2 of 2
S WL1-242-20120613

A&;A
I ENK
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http:ttportal.ncdenr.org/web/wQ/ws/su/npdessw#tab4
Permit No.: N_/C/ /
Facility Name:
County: Lip
Inspector:
Date of Inspection: _
Time of Inspection:
Total Event Precipitation (inches): 421_
Was this a Representative Storm Event? (See information below) ❑ Yes ;g No,
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary) -
A "Representative.Storm Event" is a storm event that measures greater than 0-1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this sign e, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or
1. Outfall Description: J
Outfall No. l� Struc ure (pipe, ditch, etc.) �ITC�
Receiving Stream: ✓
Describe the industrial activities that occur within the outfall drainage area: f
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C16ft! 9-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): nl
Page L of 2
Swu-242-201206 B

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 O2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 �l 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:.
1 & 3 4, 5
7. Is there any foam in the stormwater discharge? Yes
8. is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe 4fdG
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
SWU-242-20120613

+ZjjL
WDENR°
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http://portal.ncdenr.org/web/wq/ws/su/npdcssw#tab-4
Permit No.: NICK
Facility Name: _
County
Inspector:
Date of Inspection:
Time of Inspection:
or,Certificate of Coverage No_: NICIG/ 01610 / 1 / 6/ Yl
Total Event Precipitation (inches): g
No_ ajb bC
Was this a Representative Storm Event? (See information below) ' ❑ Yes X No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
8
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By tkis,lgnature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permitke or Designee)
1. Outfall Description:
Outfall No. � I Stru ure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: el
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc") and tint
(light, medium, dark) as descriptors: Cie¢&
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): N 0 #.) E
Page I of 2
S WU-242-20120613

4.- Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 42 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 © 3 4 5
6. Suspended Solids-.• Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy: r'
1 Q 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe /)W,4 - -
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
S WU-242-20120613

EmohmEW % hcwpo mmo
)X 70$5 114.UHKMUIV 1 UHIVE NH,
IVILLE N.C. 27835-7085
HILLSHIRE BRANDS
ATTN: MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD
TARBORO ,NC 27886
ID#: 449 D
DATE COLLECTED: 05/21/15
DATE REPORTED : 05/29/15
REVIEWED BY:
Stormwater
Stormwater
Stormwater
Stormwater
Stormwater
Analysis
Method
PARAMETERS
(##1, Grab)
(#2, Grab)
(##3, Grab)
(##4, Grab)
(#5, Grab)
Date Analyst
Code
BOD, mg/1
14
11
13
13
10
05/22/15
CMC
5210B-01
COD, mg/1
47
40
48
36
38
05/27/15
TRB
H8000-79
Total Suspended Residue, mg/l
8.4
9.9
12
12
13
05/26/15
SDB
2540D-97
Oil & Grease (HEM), mgf{
<5.0
<5.0
<5.0
<5.0
<5.0
05/27/15
SEJ
1664B

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 708 Oakmont Dr. Page 1 of 1
Greenville, NC 27858
environment i rnc.com
DISINFECTION
Phone [phone] • Fax [phone]
CHLORINE NEUTRALIZED AT COLLECTION
CHLORINE
pH CHECK (LAB)
CLIENT: 449 D Week: 6
IjUV
P�.
P
P
G
CONTAINER TYPE, PIG
IILLSHIRE: BRANDS
NONE
LTTN: MR. JOHN H. CHAPMAN, JR.
10 SARA LEE ROAD
C
'ARBORO NC 27886
❑
A
A
C
CHEMICAL PRESERVATION
A -NONE D-NAOH
E o
252) 641-2308
LLi
z
ui z
HiC
B HNO3 E HCL
w C - H SO F -ZINC ACETATE/NAOH
COLLECTION
Q
$
ao
C
G-NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
o
¢
U
O
¢�
Stormwater (#1, Grab)
S
3 , T
4
CLASSIFICATION:
WASTEWATER(NPDES)
Stormwater (#2, Grab)
t r
4
n...
Stormwater (#3, Grab)
I IL
t
4
DRINKINGWATER
Stormwater (#4, Grab)
. I
4
❑ DWQIGW
SOLID WASTE SECTION
Stormwater (#5, Grab)
t r
t •
4
CHAIN OF CUSTODY MAINTAINED
DURIN MENTI])ELIVERY
Y N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT 0—fo °C
REIJM UISH D B (SAMPLER)
g' I DATEMME
C)��0
REC ib BY (SIG
DATEIIIME
COMMENTS:
r
RELINQUISHED BY (SIG.
DATEMME
RECEIVED B (SI
DATEMME
RELINQUISHED BY (SIG.)
DATEMME
I
RECEIVED BY (SIG.)
DATMME
T
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for N ? 288871
=ORM #5 Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
F ILi7 TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
YPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 ml. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia [nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent, Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you,
note the "Total Chlorine at Collection' on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. if any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality Gene al Permit No. NCG060000 RECEIVED
Date submitted Z — 1 f RI
_ ao j y DEC 1 8-2014
CERTIFICATE OF COVERAGE NO. NCG06 O 1 (V 9 SAMPLE COLLECTION YEAR CENTRAL FILES
FACILITY NAME IhE *i 1ilSAjA9 dTS_S u FACILITY ACTIVITIES INCLUDE (check all that apply): DWR SECTION
COUNTYr� ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECfING SAMPLES DISCHARGING TO SALTWATERS? ❑YES PqNO
LABORATORY Enwlr� oNM J Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE -i
Total event rainfall . Sol or ❑ No discharge this period'
'OutfalI No
�. .[. €
5'amn Ae:Collected,'
aPh::r`
ma/dd/ r.'='yw
� 'F`T55,
f • m' L h;r ,'..St
'r pH; ,
e'a { ''•'��."x•
ndard;.unhs'+c
�j. ;Col),
iJi:)�i.1� '' ♦
sm ,L .
,Olf;and'Grease;t
j wi.•„2i'1: �`" J.. i pL
Fecal Collfa�rri ; w
iA'n`'e'7y�.r•4t:.r.�7�-�.:
n �.,
�� Cclonles ra04'ntil
Enterococd,;
� 1
lonles; - r�i110,m1a�
Benchrhnark'1
'sY ra- � :, t'e^k �.-
fsr ;,° , ; ;r
*.. ■ i;..
100 o�f50
:�r'
Within 6.Q -,9 0�~
:i;tti--`,,.`.!
t2Q�
7 rr.. T1.�.4 N' z 4 :a.ti e
`t 3p
c �.� sr.r ,m.
1000
s -•ti.s -' m';
r a5
•?
<
C 5, p
A
N
7,
8
<
.2SCR
<0
A r4
IV
a
3.a
< o
�4
AS
< 61n
N
I Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than SS gallons of new motor oil per month? ❑ yes Dgno
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No:''4
SampleiGollecteif,'}`
t 0il;and'Grease;�?
..:,r�c.1,`
��t4i � T55
OH,
-
-^ New, Motor 011!Usage,
Benchmark
_ .
- `36
>loo.or`5o .
6:fl = 9.0
1 Only applies to facilities that use/process meats.
2 The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if yes. complete Part B)
SWU-249 Last Revised: October 18, 2012

*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 OUTFALL7 YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an on final and one copy o this DMR includin all "No Dischar e" re orts within 30 da s o recei t o the lab results or at end o
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THISZERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under -penalty of'law, that this document and all attachrhents were prepared. under my direction or supervision imaccordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those.persons directly responsible for gathering the information, the information submitted is,
to the best of;my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permi*e)
-)A_11?11V
(Date)
Additional copies of this form may be downloaded at: http://port al.ncdenr.ore/weNwp/ws/su/npdessw#tab-4
W
SWU-249
Last Revised: October 1.8, 2012
Pn oe.. '? of I

Tarboro Bakery
SWPPP (February 2003)
Annual Comprehensive Storm Water Inspection Checklist
1. EVALUATION OF MATERIAL HANDLING AND STORAGE AREAS FOR POTENTIAL SOURCES OF
STORM WATER CONTAMINATION: (USE MONTHLY INSPECTION LIST AND ADD NOTES BELOW)
-Ar,ce h&e &-,!5,j ouo 155m Gs ►,-' A vs AREA A i5 L2,
2. OBSERVATIONS OF STRUCTURAL CONTROLS AND DETERMINATION OF PROPER OPERATION AND
APPROPRIATENESS:
Rl 44ccdoef I Cereals m,6 1-ei P2Af wi< Cvo-di~ a ,-i ►4pjJ AJj
R•R.� oP�RA-��r, �oR,R.EC�t� .
3. OBSERVATIONS OF STORM WATER DISCHARGE OUTFALLS TO ENSURE STRUCTURAL. INTEGRITY
AND EVALUATE THE PRESENCE OF NON -STORM WATER FLOW:
6j&I S ,AR Z l^) gaO8 C0ll6 X, aN'b 001 nwRMAl
4. ASSESSMENT OF IMPLEMENTATION OF SWPPP TO INCLUDE INSPECTIONS, SPILL EQUIPMENT,
CONTROL MEASURES, EFFECTIVENESS, ETC.
71►S y 9 Aro� SPr�l 4�fu ^)� f5
5. POSSIBLE CORRECTIVE MEASURES TO IMPROVE SWPPP MULEMENTATION. ALSO COMPLETE
REVISIONS LOG ON NEXT PAGE.
S w PPP �s �.� � P'eo �'�S o 6E-► �Z.7
,v6
k6v i 6 ►e'1.5 /oq s .

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Eww'ummmiml
P.O. BOX 7085, 114 OAKMONT UHIVE PHONE [phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
HILLSHIRE BRANDS
ATTN: MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD
TARBORO ,NC 27886
ID#: 449 D
DATE COLLECTED: 11/25/14
DATE REPORTED : 12/09/14
REVIEWED BY:
Stormwater
Stormwater
Stormwater
Stormwater
Stormwater
Analysis
Method
PARAMETERS
(#1, Grab)
(#2, Grab)
03, Grab)
(#4, Grab)
(#5, Grab)
Date Analyst
Code
BOD, mg/l
2.7
2.7
5.4
3.1
2.8
11/25/14 TRB
521OB-01
COD, mg/1
<20
21
27
<20
<20
12/08/14 TRB
H8000-79
Total Suspended Residue, mg/1
3.7
7.1
4.9
3.2
3.5
11/26/14 LW
254OD-97
Oil & Grease (HEM), mg/1
<5.0
<5.0
<5.0
<5.0
<5.0
11/26/14 SEJ
1664B

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 70 , 114 Oakmont Dr. Page I of I
Greenville, INC 27858
environment 1 inc.com
DISINFECTION
Phone [phone] • Fax [phone]
CHLORINE NEUTRALIZEDATCOLLECTION
tj CHLORINE
CLIENT: 449 D Week: 32
pH CHECK (LAB)
UV
p
p
p
G
CONTAINER TYPE, PIG
HILLSHIRE BRANDS
NONE
ATTN: MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD
CHEMICAL PRESERVATION
TARBORO NC 27886
A
C
A
C
U) A - NONE D - NAOH
o
EF
[phone]
Z "�
it J
�
z
Lo
B HNO, E HCL
��
LU C - H2S0, F -ZINC ACETATE/NAOH
COLLECTION
'ork"
a
o
A
M
A
U
E 4
O
G - NA THIOSULFATE
E
a
SAMPLE LOCATION
DATE
TIME
Stormwater (#1, Grab)
4
s>":
."}'gA.
,>:
si`•"
CLASSIFICATION:
❑ WASTEWATER(NPDES)
Stormwater (#2, Grab)
t�
4
`»'
:Yin
fs"
Stormwater (#3, Grab)
4
❑ DRINKINGWATER
Stormwater (#4, Grab)
4
';'s°<!
:..
}'
<}, +
<s.<..;_.
..
DWCYGW
� �
t�
ix"?`
f
::.;:
Stormwater (#5, Grab)
4
..,:.
SOLID WASTE SECTION
CHAIN OF CUSTODY MAINTAINED
ENTIDELIVERY
DURINny"
N
SAMPLES COLLECTED BY:
(Please Pdnt)
SAMPLES RECEIVED IN LAB AT-CL_94_°C
ZREL11DISHED BY G.) (SAMPLER)
�.L DATEIT E
21
RE Env BY (51
DATEMME
COMMENTS:
)ILAc�
RELINQUISHED BY (SIG.)
DATE/TIME
RECEIVED BY (SIG.
DATEMME
RELINQUISHED BY (SIG.)
DATEMME
RECEIVED BY (SIG.)
DATFJIIME
PLEASE READ instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for N O 2 S n 4 O 3
FOR as ' Grab sample in the blocks above for each parameter requested.

SAMPLING INSTRUCTIONS AND FORM COMPLETION
LURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT -IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 mi. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is the chemical of choice to neutralize chlorine. it must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water %ality General Permit No. NCG060000
Date submitted I , cQQ i q
CERTIFICATE OF COV RAGE NO: NCG06 O' 11 �P S
FACILITY NAME Cr
COUNTY Ed
PERSON COLLE ING SAMPLES 70-k; . OJnA.0AIArJ _riC
LABORATORY E ✓� rJM ..a� Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
Ow.
SAMPLE COLLECTION YEAR CU I
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES �&NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 5e or ❑ No discharge this period'
Outfail'No '
.e •y.� a r
'SampleyCoilectetl"
i .h'• L't. �.�`:,i;E1S"' ��s.+
mo/dd r.. . =
''";'rTSS
F,�ij' a�
., m L, .:-Standard'units.
pH '
lit •tS'r ! u s..a�.i@341�[J-.i-
'COD
M 1R:.~'.
m L .
:OII abd Grease Y. `
:M L.,
1
iFecal'Coljfoim�
,;Colonies era00:mh;}
' Entrerococd
�r { ,f
s Colonies, erwi00,m.IR,�
:S
Benchmark`
! ,., • ei F f ' 'd
�'r = r ° -t,,
�iQO or50.:
�— ^fr'
Wltliin 6.0 ,9Y0':
Lsi L t
;�;."12D
r •, •th.' 7" k 4
=� 30•"�:sr`'""
W r {.l^i".'_� S 9 't<n y f^r
1QOO t
,y..-BUT r ....Zr
d 5001
a
C aro
< o
C9
S i
ca
C
.O
e.,
'C oqa
< C)
.o
a
3.
Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies,
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ] yes Xno
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Ouifall IVo ' ,+i�1�SampfelCollectetl
"�r i r, ,}
_ ;�� •,.�«M, �
S �a LT .l1 .•-• _1
�, ,� ?mo/ild/yr� �r,-i
r�OII andYGrease;`ti�p+
L' A :-1!Tt' �� '�.
<,, =,m L � 4i ;
r'��w TSS;
-I r1r. V -
tt� rat". ym- L2� Y ;t'�:
pH, „
!%7 . '3/TY!�!"]}n.M�q
Stanilacdiunil ,;,X
pNew.Mator OillElsagte,�_
rY��w"�. �i�- S r,01'ifiic.��l e r
i AQ avers egal/mot�'y
Benchmark
_
30
100 0�`50
6A=9:0`:'
Only applies to facilities that use/process meats.
2 The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still.submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if ves, complete Part B)
VED
MAR 2 7 2014
CENTRAL FILES
DWQj§QG
SWU-249 Last Revised: October 18, 2012

*FOR PART A AND PART 6 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 ❑ NO10
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cony of this, DMR, including aU "No Discharge" reports within 30 days re�tjof the lab results for at end of
monitoring period In the case of "No Discharge" reportsl to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, thatAhis document and all attachments were prepared under my direction or supervision in accordance with a
. .w
system designed io assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of:my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
2 ia I.//q
(Date)
Adtlitional copies of this form may be downloaded at: http://Portal.ncdenr.or /web/wn/ws/su/npdessw#tab-4
%W,
SWU-249
Last Revised: October 18, 2012.
Nap I of

13
Emwohmmugq % kwpo @Tmq(@d
ID#: 449 D
HILLSHIRE BRANDS
ATTN: MR. JOHN H.
CHAPMAN,
JR.
110 SARA LEE ROAD
DATE COLLECTED: 02/19/14
TARBORO ,NC 27886
DATE REPORTED
: 02/27/14
REVIEWED BY.:.
Stormwater
Stormwater
Stormwater
Stormwater Stormwater
Analysis
Methoi
PARAMETERS (#1, Grab)
(#2, Grab)
(0, Grab)
(#4, Grab) (#5, Grab)
Date Analyst
Code
BOD, mg/l
<2.0
<2.0
2.8
2.8 2.5
02/20/14 TRB
521OB-0
COD, mg/I
<20
<20
<20
22 21
02/26/14 TRB
H80004
Total Suspended Residue, mg/l
7.0
14
9.0
15 13
02/21/14 CMC
254OD-9
Oil & 'Grease (HEM), mg/l
<5.0
<5.0
<5.0
<5.0 <5.0
02/21/14 SEJ
1664E

Environment I•, Inc. CHAIN OF CUSTODY RECORD
RO. Box 7085, 114 Oakmom Dr.
Greenville, NC 27858 page�— of —1
i
Phone [phone] • Fax [phone]
DISINFIs[ HON
CHLORINE NEUTRALIZED ATCOLLECTION
CI11-ORINC:
-
CLIENT: 449 D Week: 6
'
EH CHECK (LAB)
LlUV
p
P
p
G
CONTAINER TYPE,P/G
HILLSHIRE BRANDS
1
N0 4
ATTN: MR. JOHN H. CHAPMAN, JR.
CHEMICAL PRESERVATION
110 SARA LEE ROAD
!
Ll
TAR130RO NC 27886
A
C
A
C
A - NONE D - NAOH
o
[phone]
?
B HNO� E HCL
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cr Rl
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COLLECTION
F
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A
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a
F.
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G- NATHIOSULFATE
�
a
SAMPLE LOCATION
DATE
TIME
Stormwater (III, Grab)
d
4
~'' u'
?" s
�s:»:
��.
CLASSIFICATION:
WASTEWATER (NPDES)
DRINKINGWATER
Stormwater (N2, Grab)
"
`f
4
Stormwater (113, Grab)
"
4
Stormwater (H4, Grab)
,
4
w
NMI
NMI
pDWOJGW
Stormwater (N5, Grab)
4
m
SOLID WASTE SECTION
CHAIN OF CUSTODY MAINTAINED
DURING SHIPMENT/DELIVERY
r
Y N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT °C
REL4 ISHED BY ) (SAMPLER)
D, DATEMME
RECEIVED )
DATFJTIME
COMMENTS:
RELINQUISHED BY (SIG.)
DATEMME
RECEIVED BY (SI .)
DATEMME
RELINQUISHED BY (SIG.)
DATEMME
RECEIVED BY (SI ,)
DATFITIME

Tarboro Bakery
SWPPP (February 2003)
Annual Comprehensive Storm Water Inspection Checklist
1. EVALUATION OF MATERIAL HANDLING AND STORAGE AREAS FOR POTENTIAL SOURCES OF
STORM WATER CONTAMI i��ATION: (USE MONTHLY INSPECTION LIST AND ADD NOTES BELOW)
iAA� hJ '96od 4vv)&-*q W,A A)O of
2. OBSERVATIONS OF STRUCTURAL CONTROLS AND DETERMINATION OF PROPER OPERATION AND
APPROPRIATENESS: ��//�
,qll Srj&GT,/ �S � CdNn`�a �S /� /I J f2'0'od cv-J
3. OBSERVATIONS OF STORM WATER DISCHARGE OUTFALLS TO ENSURE STRUCTURAL. INTEGRrTX
AND EVALUATE THE PRESENCE OF NON -STORM WATER FLOW:
-lie �►ie oE' ,}11 or,e��s �..� �� .
See &-;UtiK is, ,,4_1_-'!Jecl 7� 50146
rs w 6
4. ASSESSMENT OF IMPLEMENTATION OF SWPPP TO INCLUDE INSPECTIONS, SPILL EQUIPMENT,
CONTROL MEASURES, EFFECTIVENESS, ETC.
al,l �- ,sc,� ems.
t� P
d
5. POSSIBLE CORRECTIVE MEASURES TO IMPROVE SWPPP IMPLEMENTATION. ALSO COMPLETE
REVISIONS LOG ON NEXT PAGE.
/Udoi/G Al )01 S 11'1n4!5 41,t5- RA?u lAC—c1.
ete and ftlanwith
Sri
Date
X�L 7
Signature of PlaAj Manager or Zone VP Date
#j j

ja
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on f lling out this form, please visit: http://portal.ncdeiir.or:z/web/wg/ws/su/npdessw#tab4
Permit No.: N/C/ I�l I_l I I or Certificate of Coverage No.: NICIG/l7/bl�l 11(�l l
Facility Name: 5
County: M Phone No.
Inspector: jghhk
Date of Inspection: 07 — i9 - ao 14 ^
Time of Inspection: , / D : 3d A!!!, —
Total Event Precipitation (inches): ' S4
Was this a Representative Storm Event? (See information below) X Yes ❑ No
Please check your, permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By thi ature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permigee or Designee)
x. Outfall nption:
Outfall No. Ye5c • Structure (pipe, ditch, etc.) —��f A
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using lsic colors
(light, medium, dark) as descriptors: - cl&- ate+ can N 0
, blue,'etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): W o - ad o g
Page l of 2
SWU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes kL0j
14. Other Obvious Indicators of Stormwater Pollution:
List and describe Ah X
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
s WU-242-20120613

XAA
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http://porW.ncdenr.oriz/web/wg/ws/su/npdcssw#tab-4
Permit No.: NI_G_I
Facility Name:
County
Inspector:
Date of Inspection: _
Time of Inspection:
� r�
Total Event Precipitation (inches): • 154
Was this a Representative Storm Event? (See information below) N Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this s�gnature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permi* or Designee)
1. Outfall Description:
Outfail No. r2 Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using
(light, medium, dark) as descriptors:
colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): &tom odb R-
Page 1 of 2
SwU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
(9 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
G. Suspended Solids:' Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
Q 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes �o
1 .
S. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes ®o
10. Other Obvious Indicators of Stormwater Pollution:
List and describe ND /V E
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
5 WU-242-20120613

GUAr
NCD NR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http://T)ortal,ncdcar.or-Jweb/wq/ws/su/nj2dessw#tab-4
Permit No.: N/C/ /_/ 1 1 /_I / or Certificate of Coverage No.: N/C/G/ 0/ W U/ l / tY Yl
Facility Name: R ,,, h t R. e
County: Phone No. c2llia— 4?(/1- C236 �? _
Inspector:
Date of Inspection:
Time of Inspection: O :
Total Event Precipitation (inches):
. Slc
Was this a Representative Storm Event? (See information below) ;K Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative. Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Pe*nittee or Designee)
1. Outfall Description: ll
Outfall No. _ 11 Stru ture (pi , ditch, etc.) . L
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using b is colors (red, brown, b ue, etc.) and tint
(light, medium, dark) as descriptors:
I Odor: Describe any distinct
chlorine odor, etc.): AVo C
that the discharge may have (i.e., smells strongly of oil, weak
5WU-242-20120613
Page 1 of 2

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 20 3 4 5
6. Suspended Solids:: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 (D 3 4 - 5
7. Is there any foam in the stormwater discharge? Yes to
8. Is there an oil sheen in the stormwater discharge? Yes 4o
9. Is there evidence of erosion or deposition at the outfall? Yes Q
10. Other Obvious Indicators of Stormwater Pollution:
List and describe 60,jlJ
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242-20120613

0
• r
HCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform, please visit. hgpl(portaLncdenr.orc-,/web/wg/ws/su/npdessw#tab4
(portal.ncdenr.orJweb/wg/ws/su/nndessw#tab-4
Permit No.: N/C/ I :I 1 =1_l = 1�l or Certificate of Coverage No.: NIC/G/01-j2l O/ 1-/ 4 l
Facility
County:
Inspects
Date of
Time of Inspection: f0; .30_ fln) _
Total Event Precipitation (inches): $ S6
Was this a Representative Storm Event? (See information below) CQ Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By tkis signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of P rmittee or Designee)
1. Outfall Description:
Outfall No. _ Structure (pipe, ditch, etc.) �l
Receiving Stream: r ktu 2,
Describe the industri activities that occur within the outfall drainage area: Wr4
2. Color: Describe the color of the discharge, using basic colo (red, brown, blue; etc.) and tint
(light, medium, dark) as descriptors: d !U
3. Odor: Describe any distinc odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): �11 IDO _; A
SWU-242-20120613
Page 1 of 2

+ . .
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge?
8. Is there an oil sheen in the stormwater discharge?
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Yes
Yes
Yes
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation. .
Page 2 of 2
SWU-242-20120613

AS
A
WDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: ht!p:llportal.nedenr.org./web/wq/ws/,su/nNessw#tab-4
Permit No.: N/C/ l_l l_l_I I l or Certificate of Coverage No.: N/CIG/OI%101-L1k1$I
Facility Name: ,'11,G Q-gt A
County: PhoneNo.,309
Inspector:
Date of Inspection: o?' 1q' /
Time of Inspection: d
Total Event Precipitation (inches)
1 �k
Was this a Representative Storm Event? (See information below) .,M Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary).
A "Representative Siorm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By thiksignature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of "ittee or Designee)
1. Outfall Description:
Outfall No. .._ Structure
Receiving Stream:
ditch, etc.) , D (2- ' 1
Describe the, industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using
(light, medium, dark) as descriptors:��rj
colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e-, smells strongly of oil, weak
chlorine odor, etc.): -A6- _
Page i of 2
SWU-242-20120613

4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
W 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes Na
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe _&AJ 16
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may
be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SwU-242-201206 t 3

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT -
sENERAL PERMIT NO. NCG060000
2ERTIFICATE OF COVERAGE NO. NCC06
. ACILITY NAME
"ERSON COLLECTING SAMPLES
:ERTIFIED LABORATORY Lab #fvl
• Lab #
'art A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2-0/.2
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives thipappling resultp from the laboratory.)
COUNTY
PHONE NO.
PLEASE SIGN ON THE REVERSE 4
Ouffall;
No
Date
Sample "
00534, " 3
.:00400
^t Total Suspended k'
f pH,
Cheinlca! Oxygen
' "f 011 andSGrease, 1
: ` Fecal.Coliform,'
Collected,' {
Solids,
t'
-' +Standard unite
1;
Demand, !
mglL ;
Colonlesper•-100 mI
mo/ddl r
' ' � 1.
:1� .
�
Within.60 -. 9:0
120 _.
30
' .:1000.:
fate: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier 2 responses.
ee General Permit text.
C.
,id this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? yes &no o
f yes, complete Part B) �' a
art B: Vehicle Maintenance Activity Monitors
'Outfall, • .: Date
No Sample'•Collected, C
�6 ,t 00530
grease, Total Suspende
100
ote: If you report a sampled value in excess of the benchmark value, or
:e General Permit text.
rORM EVENT CHARACTERISTICS:
Date first event sampled) �p
Total Event Precipitation (inches): _4 !
cr
00400
W
L
l Salids;
pA;
Stanilard,utiits •
New MOWo Oil .Usage,
..AnntjAl4iverage Rat/moJ
ark range for pH, you must implement Tier I 'or Tier 2 responses.
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
S WU-249-102107

"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 knowina violations."
(Date)
SWU-249-10210
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
3ENERAL PERMIT NO. NCGO60000
2ERTIFICATE OF COVERAGE NO. NCG06 i "$
FACILITY NAME
PERSON COLLECTING SAMPLES ✓
2ERTIFIED LABORATORYi1 Lab #
'art A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 0_2A %a
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sa ling result from the laboratory.)
COUNTY
PHONE NO. a2
PLEASE SIGN ON THE REVERSE
OutfBII:
No
.. ..
Date':
Sbmjp e., Y
Collected; j
..
00530 . `= "
;f: ,:00400.
<;�,-00340'
31616.
Total Suspended
NSollds, 7
r
:' '... •..
pH,
Standard anus
•,.. . ;,,..,..
Chemical0aygen •
Demariii, F ^
O[[,And Grease, i
mg/I. ;. f
6
, �� Fecal Coliforfi,
Colon#es per 100 al
Benchmark
.100, a."
=Wlthtn.'6.0 9:0
O
Tote: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
ee General Permit text.
lid this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes Xno
€ yes, complete Part B)
art B: Vehicle Maintenance Activi onitoring Requirements
Outf>ill,
No:
:;,: Date i
Satri�ile:Coliected,`
r
.''00556i..'...: ::`_'
00530;.=' ':_
�'i80A00
A
Oiland Grease,
t`
Total SuspendedSolids,.
'
pH,�,
:Stnadunits-.Aiiav
,New Motor :Oil �Usage,
/momn/d
enchmarli '
,. - ,30
100 .
6.0 - 9 0
ote: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier 2 responses.
;e General Permit text.
r'ORM EVENT CHARACTERISTICS:
Date s' " 1(first event sampled)
Total Event Precipitation (inches): �r 7
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
S WU-249-102107

"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 ;ny knowledge and belief,
true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including
the ossibility of ernes and imprisonment for knowing violations."
(Signature o `ttee) (Date)
SWU-249-10210
Page 2 of 2

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NICI I^l�l I I or Certificate of Coverage No.: N/C/G/ Q/-k OI 1Ifzl�l
Facility Name:
County: one No. _,2-236 %R
Inspector:
Date of Inspection: -
mature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of�tee or Designee) - —
1. Outfall Description
Outfall No. �^ Structure (vim, , ditch, etc.) 7I
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue etc.) d tint (light,
dark) as descriptors: , 0462 . !nl_A- A t qht fagaww�
3. Odor
Describe distinct odors that the disc a may have (i.e., smells strongly of oil, weals chlorine odor,
etc.) an
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
I 2 Q 4 5 6 1' 8 9 10
Page 1
5WU-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
I is no solids and 10 is the surface covered with floating solids:
1 2 �3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where I is no solids and 10 is extremely muddy:
1 0 3 4 5 6 7" 8 "9 10.
7. Foam '
Is there any foam in the stormwater discharge? Yes No
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes ®N
1V Other Obvious indicators of Storinwater Pollution
r
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
swU-2424=05

VJ ti
1 V1
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C// / - /I 1 / I or Certificate of Coverage No.: N/GG/ Ol P U/ I/ (o/ 40/
Facility Name:
County: one No. _92<0t 1-
Inspector:
Date of Inspection:
91-4w" gnetYre, I certify that this report is accurate and complete to the best of my knowledge:
(Signature o or Designee) —
1. Outfall Description
Outfall No. -c-;k- Structure Ope, ditch, etc.) r i
Receiving Stream: _%A�2 ,_ AI ye,'C,�
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (redj brown blue etc.) and tint (light, medium,
dark) as descriptors: 4C0169. ,, A )A5 ,...�f + hr 6.ic' wnl
3. Odor
Describe any distinct odprs that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) - / j.A &Gj E5.
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 30D 4 5 6 1 8 9 10
Page 1
SWU-242-020705

L-
5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 2 �3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 3 4. 5 6 7 8 9 "10
7. Foam
Is there any foam in the stormwater discharge? Yes
& Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Deposition at Oatfali -
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes
11. Other Obvious Indicators of Storrriwater Pollution
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020105

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C/ / /_I_/_I I I or Certificate of Coverage No.: N/C/G/d/�o/ dl 1 / bl dV
Facility Name:
County; P one No. 2,5;j-_ �11- -,& g
Inspector: 0 rJ
Date of Inspection:
Es s� re, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of or Designee)
1. Outfall Description
Outfall No. 3 Structure (pipe, ditch, etc.)
Receiving Stream: ` ;V_ I .J,�.2 _
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the
dark) as descriptors: --4
(red, b ow�blue, etc.) and tin { ight, medium,
3. Odor
Describe any di t'nct odorse discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) 6
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 4 5 6 7 8 4 10
Page 1
5WU-242-020705

L-
5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
l is no solids and 10 is the surface covered with floating solids:
1 2 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
l 3 4 ' 5 6 -7 ` 8' 9 "10-
7. Foam `
Is there any foam in the stormwater discharge? Yes
S. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall?
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
11. Other Obvious Indicators of Starmwater Pollution
List and describe
Yes @
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020105

Storlinwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NLC � hl_I / I or Certificate of Coverage No.: jQGI 49 6l �/�I9/
Facility Name: �
County: one No. _ z245z — (a yl_ c2 26 Y
Inspector.
Date of Inspection:
is si tore, I certify that this report is accurate and complete to the best of my knowledge_
J
(Signature of Pe-r nMee or Designee)
1. Outfall Description
Outfal I No. -T - Structure (P , , ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using
dark) as descriptors:fe►-J _ u1
3. Odor
Describe any,
etc.)
4. Clarity
(red, brown, blue, etc.) and
• r
medium,
odors t at the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 4 5 6 7 89 10
Page 1
SWU-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stonpwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 2 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
I U2 3 4 5 6 7 8 9 .10
7. Foam
Is there any foam in the stormwater discharge? Yes Q
& Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes N�
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yeso
H. Other Obvious Indicators of Stormwater Pollution
List and describe A)a 4z 4t
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
3WU-242-020705

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NICI I l - 4 I I I pr Certificate of Coverage No.: LCGGI 44l 0/�l�il
Facility Name:
County: Phod No. ci
InspectorzVq
Date of Inspection:
is tore, I certify that this report is accurate and complete to the best of my knowledge:
_ (SignaturabFRemVttee or Designee)
1. Outfall Description
Outfall No. — -- Structure ipe, ditch, etc.) j77' In
Receiving Stream: 474rZ
Describe the industrial acts rvities that occur within the outfall drainage area:
2. Color
Describe the color of the
dark) as descriptors: —j
3. Odor
Describe any
etc.) _ ,L
using basic colors
11
blue, etc.) and tint (light, medium,
the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
1 2 ID 4
5 6 7' 8' 9 10
Page 1
5wU-242-02D705

t-
5. Floating Solids
Choose the number which best describes theamount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 2 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes a
9. Deposition at Outfall_
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes �N '
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
11. Other Obvious Indicators of Stortnwater Pollution
..r
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020705
V.

STORMWATER'DISCHARGE OUTFALL (SDO)
MONITORING REPORT
;ENERAL PERMIT:NO. NCGO60600 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OECOVERAGE NO. NCG06 C`) I U R • _ , (This•monitoring report Is due atthe Division no later than 30!days from
_
the date the facility receives th a piing resal "from the laboratory.)
FACILITY NAME COUNTY
?ERSON COLLECTING SAMPLES PHONE NO.
-ERTIFIED LABORATORY Lab # ,t
Lob '# PLEASE SIGN ON THE REVERSE
'art A: Specific Monitoring Requirements
OutfaU
Date
OOS30;
OOI0000340
;E'
0055G F
3I616:
No
Sample
Total Suspepded ' `
1, pH,:
Clsemlc6l Qxygety
Oil and;Grease, .1
Fecal Coliforrtt,"'.: .
CNlallec�t/1ed,.l
a j
Solidst_ ,
V
�'$ndard':units
Demand,
mg�L
�'C�alanies:per IOO mI
'}F
dW r■R{
tenchmark: =, .
Wlthl&-6:0 .9.(I
:120
30' r ,
1000.. '
r
-a
fote: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
ee General Permit text.
,id this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes Xno
f yes, complete Part B)
art B: Vehicle Maintenance Activity Monitorine Requirements
Outfall,
;Nm
Date.
sgmo e'- 11 rGted,
:OOS56 r
00530i.
}. ;:00900
OII a� Grease, I _
Tatrt! Susmended Solids,
Standard;utiits
Ai nuM atoer,,0ilra a Ly aUmo
eiichmark::
,, h ' ..30.`
100" a:
6.4, 9:0
-
I
ote: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier Vor.Tier 2 responses.
.e General Permit text.
CORM EVENT CHARACTERISTICS:
Date -"** first event sampled) ' 7p
Total Event Precipitation (inches):
hate (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

�nf
.-ce tify, 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."
(Signatur rmittee) (Date)
S WU-249-10210
P8¢e 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
3ENERAL PERMIT NO. NCGO60000 SAMPLES COLLECTED. DURJ,NG CALENDAR YEAR:
wERTIFICATE OF COVERAGE,NO. NCG06 n 1. _ (This monitoring r'eporf Is due at' the Dlv[slon no later.than 30 days from
the date the facility receives the eanrllng result from the laboratory.)
?ACILITY NAME COUNTY IlEff
'ERSON COLLECTING SAMPLES �✓ PHONE NO. • -
;ERTIFIED LABORATORY f JU Lab #
Lab'# PLEASE SIGN ON THE REVERSE; ".
,art A: Specific Monitoring Requirements
Outfit[;.:
= > No
Samp 0
Collected,.,
mo/dill
:>Totak:Suspended k '
Solidb,
I� ¢pHf: ;; -'.:
+al$tad uWts
ndar
f.,.
Cleemical:Oxygei7
'' IJemar<d, ' , :
011 andxGrease, .a
mglX,'
. ; Fecal Cflliform, .
C�oon[es per `166 ml
lenchmgrk'
-
100.
Within:6:0 .9.0
az0 .:,:,
*� `•30
I000
r
Tote: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
ee General Permit text.
!id this facility perform Vehicle Maintenance Activities using more than SS gallons of new motor oil per month? _ yes Ano
f yes, complete Part B)
art B: Vehicle Maintenance Activity Monitoring Reoulrements
Outfall,
No: ..
:Date
Satnple'.Collected,'
tria/dd/ ri,::
'. 0055G -
00530;
OD4011 "
Oil and`Grease,
!rh
Total Suspended Solid's,
m
pH, -".
Standard�uiiits
New Motor: Oil: Usage, .
nuaiavera e" al/mo:,
enchmarlt:
30:
100
.9:0" -"
ate: if you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
se General Permit text.
rORM EVENT CHARACTERISTICS:
Date .S�.l(first event sampled)
Total Event Precipitation (inches): A 7
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

i
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or
f - 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 responsiblefor gathering the information, the information submitted is, to the best of my knowledge and belief,
true, accurate, andreomplete, �I am aware'that there are significant penalties for submittinglalse information, including
the osslbility of fines and int 'risonmea for knowing violatians."
(Signature o ttee)
(Date)
SWU-249-10210
Page 2 of 2

Stormwater Discharge 4utfall (SDQ)
Qualitative Monitoring Report
Permit No.: IWC/ / l l_! I I or Certificate of Coverage No.:
Facility Narne:
County: one No.
Inspector.
Date of Inspection:
k5lXrftn�ture, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of NM iiee or Designee)
1. Outfall Description
Outfall No. Structure ( , ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage_ area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue etc.) d tint (light, medi m,
dark) as descriptors: 4 ei A T : l�
3. Odor
Describe an distinct odors that the dischprge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.)
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
l 2 O -4
5 6 7' 8' 9 10
Page 1
SW-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with Boating solids:
1 2 U 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 02 3 4 5 6 7 8 -g .10
7. Foam
Is there'any foam in the stormwater discharge? Yes No
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) 'at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or inunediately below the outfall? Yes ®N
11.' Other Obvious Indicators of Storinwater Pon tiois
.,
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
swu-24z-MO5
k

Storinwater Discharge OutfaIl (SDO)
Qualitative Monitoring Report
Permit No.: N/C/ I /`I_I 1 I I or Certificate of Coverage No.: !QG/ 0l
Facility Name:
County: one No. 252 "l.�_ ��2s
Inspector.
Date of Inspection:
re, I certify that this report is accurate and complete to the best of my knowledge:
(Signature oTPemu or Designee)
1. Outfall Description
Outfall No. -- �� 1 -_Structure pe, ditch, etc.) _ t'
Receiving Stream: _�(.- _ -- - - - -
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red brown, blue, etc.) and tint (light, medium,
dark) as descriptors: d9kr f aJA x? yam A t , hr W rJ
3. Odor
Describe any distinct odprs that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) Ql� - - -- — --
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 C 4 5 b 7 8 9 10
Page 1
SWU-242-020705 -

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with.floiting solids:
1 2 4 5 6 7 . 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely. muddy: -
1 V 3 4. 5 6 7 "a0
7. Foam
Is there any foam in the stormwater discharge? Yes
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Deposition at Outfall -
rt
Is there deposition of material (sediment, etc.) 'at or immediately below the outfall? Yes'
10. Erosion at Outfail
Is there erosion at or immediately below the outfall? Yes
11. Other Obvious Indicators of Storniwater Pollution "
r
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020705
r

of
VdA 1`�19��
� r
Stonnwater Discharge 4utfall (SDQ)
Qualitative Monitoring Report
Permit No.: N/0 I l l_I_I I I or Certificate of Coverage No.: IVIC/Gl�/�v/ O/ II �aI
Facility Name:
County: EdQ r ne No. s0-1 - ("Vj
Inspector TON -.
Date of Inspection: _� 9 - J
zs�s� , I certify that this report is accurate and complete to the best of my knowledge:
_ (Signature of or Designee)
1. Outfall Description
Outfall No. _ ; Structure ( ipe, ditch, etc.)' _
Receiving Stream: t �•.
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the
dark) as descriptors:.__4
3. Odor
Describe any
etc.)
UNNE L"N j
(red, wq, blue, etc.) and
medium,
odors mate discharge may have (i.e., smells strongly of ail, weak chlorine odor,
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
1 2 4 5 6 '1 8 9 10
Page 1
SwU-7a2-020705

r
5. Floating Solids
Choose the number which best describes the 'amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 2 6 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy: -
r
1 3 4 5 6 7- $' 9., •10..
7. Foam
Is there any foam in the stormwater discharge? Yes
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall?
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
il. Other Obvious Indicators of Stoi nwater Pollution
List and describe -4)0 4�6k ritl"i hg-A,14 Ve�,A
r
Yes' " @
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020705
s

WA
Stormwater Discharge Dutfall (SDO)
Qualitative Monitoring Report
Permit No.: N/G I 1,/_/ l / I or Certificate of Coverage No.: N/CIG/ —! Ll I I9IOl
Facility Name: A
County: one No. tMQ 62V /- 136 0-
Inspector:
-Date of Inspection:
is su to , I certify that this report is accurate and complete to the best of my knowledge:
J
(Signature of or Designee)
I. Outfall Description
Outfall No. Structure (PAX, ditch, etc.)
Receiving Stream: �Aa� ldz_ 2
Describe the industrial activities that occur within the ouutfall drainage area::
2. Color
Describe the color of the discharge using bas'c coi
dark) as descriptors:
d, brown, blue, etc.) and ti t (light, medium,
Y
3. ' Odor
Describe any dist' c,t odors that the discharge may have (i.e., smells strongly of ail, weak chlorine odor,
etc.) - — /1 n
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 3 4 5 6 7 8 9 10
Page I
SWU-242-020705 -

S. Floating Solids
Choose the number which best describes the arnount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with.floating solids:
1 2- 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy: -
12 3 4 5 6 7 „ 8 - "9' 4 10
7. Foam
Is there any foam in the stormwater discharge? Yes
8. Oil Sheen
Is there an oil sheen in the stonmwater discharge? Yes N
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes (S
11. Other Obvioim'Indicators of Stormwater Pollution
List and describe(Z�J�
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
5WU-242-020705
s

,y Der k '9
_ r
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N
Facility Name:
County: _-&
Inspector:
Date of Inspect
is re, I certify that this report is accurate and complete to the best of my knowledge:
'r
(Signature—d-ReaNnee or Designee)
I. Outfall Description
Outfall No. �Structure ipe, ditch, etc.) y�� '� Ti2if _
Receiving Stream:
Describe the industrial activities that occur within the outfal] drainage area:
2. Color
Describe the color of the discharge using basic col I , m b own, blue, etc.) and tint (light, mediu,
dark) as descriptors: ^}
3. Odor
Describe any ifiptinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) _ 06VO
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 4
5wU-M-=705
5 6 7' 8' 9 10
Page 1

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids.
1 2 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy: -
l 3 4 5 6 7 8' 9 10
7. Foam
Is there'any foam in the stormwater discharge? Yes
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall;
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? YesV
11. Other Obvious Indicators of Stormwater Pollution
List and describe�,�
Note. Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-2424rA705

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
:;ENERAL PERMIT NO. NCG060000
2ERTIFICATE OF COVERAGE NO. NCG06_
+ACILITY NAME i`HL"8
'ERSON COLLECTING SAMPLES �4r
.ERTIFIED LABORATORY Lab #
Lab #
'art A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: C?01
(This monitoring report is due at the Division no later than 30 days from
the date the facllity receives the sam 1 ng result from the laboratory.)
COUNTY f
PHONE NO. {.)
PLEASE SIGN -ON THE REVERSE 4
Outfall;..
.., ;
4453Q '`:
' 0Q4Q0.
:::: ?Q0340' ,' :
::,00556<<:
31616:
:..,Date
..`;
: :.,.,
..:'.
, ...
SampleH°
'No ,,
csl,C6liform,
Collected,:
Solids, ,
Standard units
Demand,
r m`gIL V �''
Colonies per 100 nil
:enchmark"
'100,
Within 6.'0 — 9.0
120 ;'
3 30
1000
.. rr
�-
�
gao
fote: Ifyou report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses,
ee General Permit text.
lid this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes x no
f yes, complete Part B)
art B: Vehicle Maintenance Activity Monitorine Requirements
'Outfall,
No
::::...:!,. Date s: -
Sample:Collected
mo/dal/
, ' . OOS56=•:., +,,t: _
00530�. s
z
O11 and Grease,
Total Suspended Solids,;,
p H;7 ,
`Standard;uaits ; .
e
N w.Mator;011 Usage;
-Annual"avera a gat mo
100; -J
,6.0,=9.4y
-,
ote: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
se General Permit text.
FORM EVENT CHARACTERISTICS:
Date 111 11 (first event sampled)
Total Event Precipitation (inches): + y s
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
WE
S WU-249-102107

•
"1 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 any knowledge and belief,
true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including
the possibility of tunes and imprisonment for knowing violations."
� �1�30�aA11,
(Signature o ittee) (Date)
SWU-249-10210
Page 2 of 2

i
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
3ENERAL PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: (94 1 1
7ERTIRICATE OF COVERAGE NO: NCG06„ 01(This monitoring report is due at the Division no later than 30 days from
the date the facility receives tA�saming resul s from the laboratory.)
TACILITY NAME COUNTY'ERSON COLLECTING SAMPLES PHONE NO-V1736
;ERTIFIED LABORATORY d o Lab #�
'Lab'# PLEASE SIGN ON THE REVERSE 4
'art A: Specific Monitoring Requirements
O.utfall:
Date .
00530� "
00400.
s.00340
:,005S6i.
ti;:31616: : .
No
Sample ,
.Total Suspended°
. �:<�pH, -
; Cheinlcal"Oxygen ;
Oil.anci;Grease;
f Fecal ColIform,`
_
Collected;
n
Solids, i
f
$tandard units
Demant�, ; ':
,M
mglL
Colonies'p'er. l©0 mh
P .a
ml
:enchmark" ..
:. _ .. .:, :::
. •. r;.. '100..
Within";6 0 - 9.0
; 120..
30
xI000.,
v
t
1<
tote: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
ee General Permit text.
,id this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes —no
f yes, complete Part B)
art B: Vehicle Maintenance Activi onitorinst Requirements
,Outfall
No:
Date
Sainple'Collected;'
mo/dd/ r .i..,
i00556
00530i
'}' i00A00'.;;,
f..•
Oil and Grease,
n .,. �`itt /L. '>, ..
Total Suspen[led:Sollds,
" m
pH
Standai d .units .
N6w,Mot6r-Ol1 Usage,
Annualf'avera a sumo :;
erichmark :
30 .
.100 ,
6.0.= 9
Dte: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier 2 responses.
.e General Permit text.
FORM EVENT CHARACTERISTICS:
Date II-q"ri (first event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
S WU-2a9-102107

r
"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 any 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."
(Signatur P mittee) (Date)
SWU-249-10210
Page 2 of 2

SARA LEE BAKERY
ATTN: MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD
TARBORO ,NC 27886
ID#: 449 D
DATE COLLECTED: 11/04/11
DATE REPORTED : 11/11/11
0/11,
RBVXBNED BY: "I.I;K=
001
Stormwater Stormwater Stormwater Stormwater Stormwater
PARAMETERS
(#1, Grab)
(#2, Grab)
(#3, Grab)
04, Grab)
05, Grab)
BOD, mg/l
2.3
2.1
2.3
2.2
2.1
COD, mg/l
<2
<20
<20
20
<20
Total Suspended Residue, mg/l
7.9
7.7
10
8.6
9.2
Oil & Grease (HEM), mg/I
<5.0
<5.0
<5.0
<5.0
<5.0
Analysis Method
Date Analyst Code
11/04/11.
TRB
SM5210B
11/09/11
TRB
HACH8000
11/04/11
MEL
SM2540D
11/09/11
SEJ
EPA1664A

Env'ity at i, Inc. CHAIN OF CUSTODY RECORD
R-O. Box 7085, 114 Oakmont Dr. Page 1 of
Greenville, NC 27858
Phone [phone] • Fax [phone]
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
CHLORINE
CLIENT: 449 D Week: 32
UV
pH CHECK (LAB)
P
P
P
G
CONTAINER TYPE, PIG
SARA LEE BAKERY
NONE
ATTN: MR. JOHN H. CHAPMAN, JR.
A
C
A
G
CHEMICAL PRESERVATION
110 SARA LEE ROAD
TARBORO NC 27886
A -NONE D-NAOH
Zo
[phone]
w t
Z�
'd
- z
z
B-HNO, E-HCL
Ir
o
a�
a
C - H2SO, F -ZINC ACETATE
COLLECTION
UQ
U
o St
¢6
a g
6
o
O
GG��
G-NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
Stormwater (#1, Grab)
Al
4
CLASSIFICATION:
WASTEWATER (NPDES)
❑ DRINKING WATER
Stormwater 02, Grab)
4r;
V
Stormwater (#3, Grab)
"
ti
4
r
4
RIMER,
R.
Stormwater (#4, Grab)
4
.
DWOJGW
SOLID WASTE SECTION
Stormwater 05, Grab)
t+
►.
4
;r
�`�
��'�
�:� �.
, •
$ ��`
CHAIN OF CUSTODY MAINTAINED
DURING SHIPMENT/DELIVERY
Y N
SAMPLES COLLECTED BY:
(Please P6nt)
SAMPLES RECEIVED IN LABAT ' A °C
N ! Y (SIG. SAMPLER)
A ME
3�
REC Y (SIG.
DATFJTIME
COMMENTS:
/ , 1-��
QUlSHED BY G.)
ATEMME
RECEIVED BY (SIG.)
ATE�ME
RELIN(�UISHED BY (SIG.)
DATE/TIME-'RECEIVED
BY (SIG.)
DATEIIIME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a V for composite sample or a "G" for No 224024
FOAM#5 r_.,� . ,..,.,i.... •►. ��__�. �_.._ -- - ..... _

SAMPLING INSTRUCTIONS AND FORM COMPLETION
�^ FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLE, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the established guidelines will need to be re -collected. The client will be contacted and informed of the
deviation and asked to collect another set of samples. The client may wish for the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2)Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is not
permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 mi. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the Iab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total K3eldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent.Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosulfate is t he chemical of choice to neutralize chlorine. It must be added to your sample and them the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection' on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD samples have a 48 hour holding time and are set in the lab Monday through Friday.
Other samples such as Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS also have a 48 hour holding time. The
lab reserves the right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
These sample bottles may contain acid or other corrosive and potentially harmful chemicals. Laboratories are required to add these
chemicals for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling
the bottles. If any chemical should get on your skin or clothes, flush liberally with water and seek medical attention.

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C/%/ O/ 4 / 0/ 0 / U / O/ or Certificate of Coverage No.: N/C/G/ O/w/ 0101 o/ O/
Facility Name. .
County: '°Phone No. _a 5�- J3 6
Inspector: - trA ,,s.',A&AM A..3 Tit
Date of Inspection:
Bqt! ZI ertify that this report is accurate and complete to the best of my knowledge.
(Signature of Pe tt or Designee)
1. Outfall Description
OutfaIl No. �� Structure {pi , ditch, etc.) _
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, bl e, etc.) and tint (light, medium,
dark) as descriptors: 4 J ��g _. �6 1.'I� - w� L 1, Aye k&6i,
3. Odor
Describe any distinct odors that the Pischarge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) _ Lids P1a
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 0 3 4 5 6 7 8 9 10
Page 1
SWU-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 © 3 4 5 6 7 8 9 to
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 0 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes
11. Other Obvious Indicators of Stormwater Pollution
List and describe /vcw E F ,& w41+va 1 a�
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SwU-2424=705

Permit No.: N/C/
Facility Name:
County: 15CIA
Inspector.
Date of Inspection:
By this s I
CLqqii�1<
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
ce 'f that this reportis accurate and complete to the best of my knowledge:
(Signature of Permittee o es ee)
1. Oulf'all Description
Outfall No. c,10 Stricture (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: t4
2. Color
Describe the color of the discharge using basic
dark) as descriptors: 9--�1Z
(red, brown, blue, etc.) and tint (light, medium,
3. Odor .
Describe any distinct odorss that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) ----A)n--- —,a 9= — — — -
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
1 � 3 4 5 6 7 8 9 10
Page 1
5WU-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 10 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
l © 3 4 5 6 7 8 9 16
7. Foam
Is there any foam in the stormwater discharge? Yes ®N
8, Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes 00
9. Deposition at Outfall
Is there deposition of material (sediment, etc_) at or inmiediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
11. Other Obvious Indicators of Stornnwater Pollution
r
List and describe Q��rSpS_qln. - . .
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020705

WA
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NICI I /`I / I I / or Certificate of Coverage No.: N/GG/ Lf V/ U/0/6/ V /
Facility Name:�1
County: .{CaM b� _ P ne No.
Inspector: 0,Q&I Oyl
Date of Inspection:
By this signature, �e - t 's Wport is accurate and complete to the best of my knowledge:
1. Outfall Description
Outfall No. 3 Structure (piDe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge usin basic color (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors:
f
3. Odor
Describe any distinct odors at the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) — - r p
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 21 3 4 5 6 7 8 9 1p
Page I
swU-242-020705

t--
5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 © 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
l C2J 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes
S. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
11. Other Obvious Indicators of StormwatWPollution
r -
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020705

of VJ A Tj A
al-TAI! ` .
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: WC/ / /-- I - / / - - - -
Facility Name: —
County:
Inspector:
Date of Inspection: 11-41.
By this signature, I e� that i;
is accurate and complete to the best of my knowledge:
(Signature of Permittee or Desi
1. Outfall Description
Outfall No. _ Structure (pi , ditch, etc.)
Receiving Stream:
Describe the i dustrial tivities that occur within the outfall drainage area: t..1 �.
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors:
3. Odor
Describe any
etc.)
4. Clarity
odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
16 AJ 16
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 � 3 4 5 6 7 S 9 I0
Page I
5WU-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
I 'V9 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 3 4 5 6 7 $ 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No
S. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall?_ Yes.
10. Erosion at Outfall v
Is there erosion at or immediately below the outfall? Yes la
11. Other Obvious Indicators of Stormwater Pollution
-r
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020705

Permit No.: N/C/
Facility Name:
County: 94
Inspector:
Date of Inspection:
VZZI—
By this signatr
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
ertif�y this report is accurate and complete to the best of my knowledge:
tz-mgnature of retmrttee or l7c:&M
1. ' Outfall Description
Outfall No. Structure
Receiving Stream:
Describe the industrial a4tivitipc the
2. Color
ditch, etc.)
T within the outfall drainage area:
t
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors:
r .
i
3.' Odor
Describe any distinct odors that a discharge may have (i.e., smells strongly of oil, weak chlorine odor,
_ - � etc.) p /7Ad�' --
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
I 2 3
4 5 b 7
Page 1
8 9 10
SWU-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
i is no solids and 10 is the surface covered with floating solids:
1 O2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stonnwater discharge
where I is no solids and 10 is extremely muddy:
I C? 3 4 5 6 7 8 9 10.
7. Foam
Is there any foam in the storinwater discharge? Yes Q
0
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes (29
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes .
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes
11. Other Obvious Indicators of Stormwater Pollution
r
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
swU-242-=705

•
•
Tarboro Bakery
SWPPP (February 2003)
Annual Comprehensive Storm Water Inspection Checklist
1. EVALUATION OF MATERIAL HANDLING AND STORAGE AREAS FOR POTENTIAL SOURCES OF
STORM WATER CONTAMINATION: (USE MONTHLY INSPECTION LIST AND °ADD NOTES BELONY)
A-)) AA64,S 19Nd 4tArjj NO .6
L#4 15,19 ej S
2. OBSERVATIONS OF STRUCTURAL CONTROLS AND DETERMINATION OF FROPER OPERATION AND
APPROPRIATENESS:
oZ1 C"")-6 jme'A ,vx1qS pwc- 1 pi 9acj slept
w t4 A);) L -56 L-t6-5
-. OBSERVATIONS OF STORM WATER DISCHARGE OUTFALLS TO ENSURE.STRUCTURAL LNTEGRrry
AND EVALUATE THE PRESENCE OF NON -STORM WATER FLOW:
6JIfthe) eP,�5 )rJ qa--J Ctx-JdIt"'610 W4 no
4. ASSESSMENT OF IMPLEMENTATION OF SNVPPP TO INCLUDE INSPECTIONS, SPILL EQUIPMENT,
CONTROL MEASURES, EFFECTIVENESS, ETC.
►gnld eo
5. POSSIBLE CORRECTIVE MEASURES TO IMPROVE SWPPP IMPLEMENTATION. ALSO COMPLETE
REVISIONS LOG ON NEXT PAGE.
/vo c�,eaE�k''�E /Y? Q!�-s ,2c .v dcaD
rS flnE

. ,
r
r .
1
f r
ti
= s
= s
•

r STORMWATER DISCHARGE OUTFALL.,(SDO)
MONITORING REPORT
,ENERAL PERMIT NO. NCGO60000 �p -SAMPLES COLLECTED DURING CALENDAR YEAR: Obt'
CERTIFICATE OF COVERAGE NO. NCG06 ` 0.1; O (This monitoring report Is due at the Division no later than 30 days.from
the date the facllltyreceives the sam 'I "g•resul "froxii the laboratory.),
FACILITY NAME 666 COUNTY - a
'ERSON COLLECTING SAMPLES AN PHONE NO. (,�j
�ERTIFIED LABORATORY Lab # y4 41�
L'ab # PLEASE SIGN ON THE REVERSE
i
'art A: Specific Monitoring Requirements
:.: Otltfall ..::
": ':,:: NO -; : ;,
` OU534
;00400.
�. 00340 ;: °: ;' : ?,
; 00.556>; r
; ;r: 31616
No
Stim}il�
� Total Sttspended a,"
�; �,S pH,
Cheinlcal.Orygen
�011 and Grease,
Fecal C611 orM, -
Ctiilected,
Solids
Sta>idard units
Il&i ii id'
mglL'
' C�a�ninies per 100 ml
}�f 9 ,
.L-
I "C f �.,,,
- , n 1
d-
3
uio�aar
Y
r
tenchmark:....
;,, I00,• :. ;>.. .: ,
' �Vithln 6b0 -. 9:0 :.-:
:120:•
30 r
=; 1000..
ffr4
CIA
t
Tote: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier 2 responses.
ee General Permit text.
,id this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes x no
f yes, complete Part B)
art R! VAIrin Maintenance Aetivitv Mnnitnrine RPnnirPm Pnhe
Outfall,
No
Date
Sample;�ollected'
nfv/dd/ �., •,
00$56:#
- 00530' ; : ;.
•A0400-<
O1l a'nd GreaffC"
�m * : , ..
Total Suspended'Solids,;
m .., :
pH, ,
$tanifardmn s
+New Motor;Oil,usage, .
Annt iil"averse aUmo
erichmark::
;G,O;= 9 0
ote: it you report a sampled value to excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
,e General Permit text.
CORM EVENT CHARACTERISTICS:
Date 111-11 (first event sampled) f
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
M
v �
n
r3
t
r.
m
QTTRT'4An 1^n.

"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, .4 am aware_ that thereare significant penalties for submitting false information, including
the possibility of fines and imlirisonment for knowing violations."
„`�1�3Q�2A11
(Signature o ttee) (Date)
SVIU-249-10210
Pace 2 of 2

STORMWATER DISCHARGE OUTFALL (560)
MONITORING REPORT
MNERAL PERMIT NO. NCGO60000 ,,rr��
2ERTIFICATE OF COVERAGE NO. NCG06 V ^l (a'
FACILITY NAME
'ERSON COLLECTING SAMPLES
:ERTIFIED LABORATORY d e Lab #
Lab#,
'art A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING.CALENDAR YEAR: o94 1 1-
(This monitoring report is due at the�Dlvlslon no later -than 30,days from
the date the facility receives the sum ling resul.s from the laboratory.)
COUNTY
PHONE NO. •
PLEASE SIGN ON THE REVERSE,4
Qntfall :.. ..
No
Date :
Sample
Ca
00530
00556'.
31616. '
Total Suspended a
ySoiids,
', , }� phi, .;
`�a' tandadunts r
-htr#facl.Uxygen .
n#
i
` , 011,•and Grease, +
m
, ' Fecal Coliform,
;olonles eplected r 100 m1
�enc}tmark , •
100,
.WIthln:6'0 - 9.0
" 120.
F 34
3000.:0L
• /r
t LSD
r
a77Sao
.
tote: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
ee General Permit text.
,id this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _no
f yes, complete Part 13)
art B: Vehicle Maintenance Activity Monitoring Requirements
Outfell.
No..
Date
Sample Collected;
mo/ddl r,;..
00$S6 -
00530;•.
:00400.-:F,
oil: and Grease;
din
Tote! Suspended Solids,'
m
pFi,
Stanclard,uiilts
New Motor.OlGUsage; ..
Annua['avera a al/mo
enchrnsrk:
,, `;Y • , 30
9.0
ate: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
:e General Permit text.
FORM EVENT CHARACTERISTICS:
Date II-y-li (first event sampled)
Total Event Precipitation (inches): , �?i
Date — (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
4211rTT_lAn 1tv1i A^i

"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 any 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."
(Signatur P mittee) (Date)
SVM-249-10210
Page 2 of 2

Elowkomums[W Ala 01mompombd
SARA LEE BAKERY
ATTN: MR. JOHN H. CHAPMAN, JR.
110 SARA LEE ROAD
TARBORO .NC 27886
PARAMETERS
ID#: 449 D
DATE COLLECTED: 11/04/11
DATE REPORTED : 11/11/11
REVIEWED BY
Stormwater Stormwater Stormwater Stormwater Stormwater
(#1, Grab) (#2, Grab) (#3, Grab) (#4, Grab) (#5, Grab)
Analysis Method
Date Analyst Code
BOD, mg/l 2.3 2.1 2.3 2.2 2.1 11/04/11 .. TRB SM5210B
COD, mg/! <2 <20 <20 20 <20 11/09/11 TRB HACH8000
Total Suspended Residue, mgll 7.9 7.7 10 8.6 9.2 11/04/11 MEL SM2540D
O0 & Grease (HEM), mg/1 <5.0 <5.0 <5.0 <5.0 <5.0 11/09/11 SEJ EPA1664A

E"`�"-mot 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr. Page 1 of
Greenville, NC 27858
Phone [phone] • Fax [phone]
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
CHLORINE
pHCHECK (L.AB)
CLIENT: 449 D Week: 32
LjUV
P
P
P
G
CONTAINER TYPE, PIG
SARA LEE BAKERY
Ij NONE
ATTN: MR. JOHN H. CHAPMAN, JR.
A
C
A
C
CHEMICAL PRESERVATION
110 SARA LEE ROAD
TARBORO NC 27886
A -NONE D-NAOH
oz
[phone]
zzo
Z ,
B - HNO, E - HCL
0 8
U Q
I
a
C-H2SO4 F-ZINCACETATE
COLLECTION
ri: 8
tz
G-NATHIOSUL.FATE
SAMPLE LOCATION
DATE
TIME
Stormwater (#1, Grab)
11 l�'
`
4
su i
�• t
4h
k•:a
' xt
CLASSIFICATION:
❑WASTEWATER(NPDES)
Ll DRINKINGWATER
Stormwater (#2, Grab)
fi
11
4
a
h
Stormwater (#3, Grab)
tt
ti,
4
IN
..:>
Stormwater (#4, Grab)
4
ztc
:¢
#$
s a7a
t�
Stormwater (#5, Grab}
s.
4
SOLID WASTE SECTION
CHAIN OF CUSTODY MAINTAINED
DURING SHIPMENT/DELIVERY
Y N
SAMPLES COLLECTED BY:
(Please Prim)
SAMPLES RECEIVED IN LAB AT (:�' fk °C
Y(SIG. SAMPLER)
ATE/TIME
3�
REC Y(SIG.
DATETHME
COMMENTS:
FEQUIISHED
rf ram;
7
BY G,J
ATEMME
RECEIVED BY (SIG.)
ATEIRME
RELINQUISHED BY (SIG)
DATEIIIME
RECEIVED BY (SIG)
DATEfTIME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for o
224'024
FORM #5 (;rah camnla in Iha hlnnVn eh.,,,.. $— nnnl...nrn

SAMPLING INSTRUCTIONS AND FORM COMPLETION
y FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLE, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the established guidelines will need to be re -collected. The client will be contacted and informed of the
deviation and asked to collect another set of samples. The client may wish for the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody" specifying the deviation. The laboratory is also required to send a letter to the State noting the
deviations.
2)Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or less. Freezing is not
permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. In this case the
temperdture at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 ml. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent.Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosul fate is t he chemical of choice to neutralize chlorine. It must be added to your sample and them the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be before any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coli form and Enterococci samples have a holding time of 6 hours from time of collection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD samples have a 48 hour holding time and are set in the lab Monday through Friday.
Other samples such as Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS also have a 48 hour holding time. The
lab reserves the right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
These sample bottles may contain acid or other corrosive and potentially harmful chemicals. Laboratories are required to add these
chemicals for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling
the bottles. If any chemical should get on your skin or clothes, flush liberally with water and seek medical attention.

Stormwater Discharge Outfall (SDO) .
Qualitative Monitoring Report
Permit No.: MG0/ 0l (P/ U/0/U/O/ or Certificate of Coverage No.: N/GG/OI
Facility Name:
County: hone No. S;7-- y! - r 1 & S -
Inspector.
Date of Inspection: _ f/-,V- !/
B I ertify that this report is accurate and complete to the best of my knowledge:
(Signature of Pe 'tt or Designee)
1. Outfall Description
Outfall No. l - Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge
dark) as descriptors.+4
3. Odor
Describe any distinct odors that the
etc.) _ ff 5 wja !f!1
using basic colors (red, brown, bl e, etc.) and tint (light, medium,
may have (i.e., smells strongly of oil, weak chlorine odor,
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
1 �2 3 4 5 ti 7 8 9 10
Page 1
5wU-242-02D705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
I is no solids and 10 is the surface covered with floating solids:
1 © 3 4 5 6 7 S 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No
8. Of Sheen
Is there an oil sheen in the stormwater discharge? Yes �..�
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes
11. Otha r'Obvious indicators of StormwaterPollution
List and describe ZVrA E e corAI nIn &SaX6 a iu . _-
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020705

Stormwater Discharge Outfall (SDQ)
Qualitative Monitoring Report
Permit No.: NICI 1 1 I / I or Certificate of Coverage No.: rUGG/ O/(_P/O/ 0/0/Q/
Facility Name:
County: !�� - one No. 6 Y
Inspector
Date of Inspection:
By this s Ice that dais report is accurate and complete to the best of my knowledge:
(Signature of Peranittee o es )
1. OutfaIl Description
Outfall No. q2' Structure (pipe, ditch, etc.) .
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors: [P-24A M0 ep 19 -- _ - -
3. Odor r
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) - �/Q a
4. Clarity
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
I U 3 4 5 6 7 8 9 10
Page I
5wU-242-=05

5. Floating Solids
Choose the number which best describes the amdunt of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 10 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where I is no solids and 10 is extremely muddy:
1 © 3 4 5 6 7 8' 9 `10
7. Foam
Is there any foam in the stormwater discharge? Yes LNG'
S. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes 00
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) 'at or immediately below the outfall? Yes
10. Erosion at Outfali
Is there erosion at or immediately below the outfall? Yes Na
11. Other Obvious Indicators of Stormwater koliirtion
List and describe . E96AA61fyci
rL kA CL
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242.ON705

O� VVA
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C/ I /`/ - / / / I or Certificate of Coverage No.: &QG/ G�%/ O/O/Q/ a/
Facility Name: 6� _-
County: 9CCOM )Q Adne No. - Q�V
Inspector :1 h MJ h A llM (R*J - ;:rL
Date of inspection:
By this signature, �et tth*t 's tpport is accurate and complete to the best of my knowledge:
(Signature of Permittee or Design
1. Outfall Description
Outfall No. 3 Structure( , ditch, etc.)
Receiving Stream:T'q4 2,
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge usi basic col (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors:
3. Odor
Describe any distinct odors t the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) — Ai o a is4- - - - -
4. Charity
Choose the number which best describes the clarity of the discharge wfiere 1 is clear and 10 is very
cloudy-
1 20 3
4 5 6 7- 8' 9 10
Page 1
SWU-242-020705

S. Floating Solids
Choose the number which best describes the.amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating. solids:
1 © 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 C2J 3 4 5 6 "7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfail
Is there deposition of uiatarial (sediment, etc.) at or immediately below the outfall?
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
11. Other Obvious Indicators of StormwatWPollution '
List and describes
Yes (9
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and connective action.
Page 2
SWU-242-O 705

Permit No.: NLC /
Facility Name:
County:
Inspector;
Date of Inspection:
By this signature, I i
�3
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
report'is accurate and complete to the best of my knowledge:
(Signature of Pemrittee or Desjv-le�
1. OWN Description
Outfall No. Structure (pi)e, ditch, etc.)
Receiving Stream —
Describe the irldustrial tivities that occur within the outfall drainage area: �•
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as de=ptors:-
- ..r
3. odor
Describe any i
etc.)
UEEN �_. r l A
odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 3 4 S 6 7 8 9 10
Page 1
5WU-242-020M

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with.floating solids:
1 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 3 4 5 6 7 8� 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No
S. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall?
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes a00
11. Other Obvious Indicators of Stormwater Pollution
r
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-02WO5

Permit No.: &C
Facility Name: '
County: - A"
Inspector:
Date of Inspection:
By this signatu ,
WALi�?
r
'-1
EPIC
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
or i icate of Coverage No.:
(Signature of Pertnittee or DmigN
1. Outfall Description
Outfall No. �5 Structure
Receiving Stream: � �9 & .
Describe the industrial as ivitiss th
2. Color
report is accurate and complete to the best of my knowledge:
ditch, etc) -.-���In - --
r within the outfall drainage area:
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors:
3. Odor
Describe any distinct odors that)he discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) - � �AdI�- - -
Choose the number which best describes the clarity of the discharge where I is clear and 10 is very
cloudy:
1 62- 3 4 5 6 7 8 9 10
Page 1
swv-2424=05

S.-
5. Floating Solids
Choose the number which nest describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 (2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
l �2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes ©o
8. Oil Sheen
Is there an oil sheen in the stortnwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sedirnent, etc.) 'at or i.mmediately:below the.outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes
11. Other Obvious Indicators of Stormwater Pollution
r
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2 .
SwU-242-UM05 '

Tarboro Bakery
SWPPP (February 2003)
Annual Comprehensive Storm Water inspection Checklist
1. EVALUATION OF MATERIAL HANDLING AND STORAGE AREAS FOR POTENTIAL, SOURCES OF
STORM WATER CONTAMINATION: (USE MONTHLY INSPECTION LIST AND ADD NOTES BELOW)
&)) Ai:?,644S taJj 4qJd NO
pu
�' b 5 .
1
2. OBSERVATIONS OF STRUCTURAL CONTROLS AND DETERMINATION OF PROPER OPERATION AND
APPROPRIATENESS:
O z l co,)-6, ,,j 6 e A A-kCA 5 AZE I tJ q ao� 86Q,�_
W4 riD 06LA�
3. OBSERVATIONS OF STORM WATER DISCHARGE OUTFACES TO ENSURE -STRUCTURAL INTEGRITY
.AND EVALUATE THE PRESENCE OF NON -STORM WATER FLOW:
A ► &J411:3 A) qecJ cam► d,t',i j wtu ruo
619 ..J 5 r_>-(� /U'l - S �m e'� aQ, _�l o Lj .
4. ASSES5MENT OF CATION OF MM TO INCLUDE INSPEC13ONS, SPILL EQUIPMENT,
CONTROL MEASURES, EF'FEGTWENESS, ETC.
N 1s
S. POSSIBLE CORRECTIVE MEASURES TO IMPROVE SWPPP RdPLEMENFATION. ALSO COMPLETE
REVISIONS LOG ON NEXT PAGE.
Note: Complete and ftle„4vijh monthly
ERR
Signature qfPfaqtNanager or Zone VP

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