NCG060349_MONITORING INFO_20190523

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v C&QbD
DOC TYPE
0 HISTORICAL FILE
MONITORING REPORTS
DOC DATE
� D OI 5 U s a 3
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 05/13/2019
CERTIFICATE OF COVERAGE NO. NCG060349 REC V�; AMPLE COLLECTION YEAR 2019
FACILITY NAME Ann's. House of Nuts I�CC FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Martin MAY 2 Z019 ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES _ Michael Speller DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY Environment 1 Lab Cert. # 10 GhN I KA,L FII'_ES
DWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall' or ❑ No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100 ml
Enterococcil,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 — 9.0
120
30
1000
500
1
05/13/2019
91
6.7
133
<6
2
05/13/2019
8.2
6.7
32
<6
3
05/13/2019
3.6
6.4
23
<5
4
05/13/2019
3.7
6.7
24
<5
1 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.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes X no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 504
6.0 — 9.0
-
(if es, complete Part B)
1 Only applies to facilities that use/process meats.
z The total precipitation must be recorded using data from an on -site rain gauge.
s For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012
Page I of 2

*FOR PART A AND PART B MONITORING RESULTS:
+ A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 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: Thom Edgerton 01/31/19
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end o
monitoring period in the case o "No Discharge" reports) to:
Division of Water Qu lity
Attn: DWQ Central Fi es
1617 Mail Service Ce ter
17
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."
Cox
(Signature of Permittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2 of 2

3 SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 01/31/2019 _
CERTIFICATE OF COVERAGE NO. NCG060349 !� p EC E I,� E SAMPLE COLLECTION YEAR 2018
FACILITY NAME Ann's House of !Nuts FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Martin FEB 18 2019 ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Michael Speller DISCHARGING TO SALTWATERS? []YES ®NO
LABORATORY Environment 1 Lab Cert. #i 10 UtN I KAL FILES
DWR SECTION\ PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall 2 or ❑ No discharge this period'
Outfall No.
Sample Collected,
nio/dd/yr
TSS,
- mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100 ml
Enterococcil,
Colonies per 100 ml
Benchmark .
-
100 or 504
Within 6.0 — 9.0
120
30
1000
500
1
12-20-18
39
6.3
67
<6
2
12-20-18
22
6.8
62
<6
3
12-20-18
<2.6
6.2
21
<5
4
12-20-18
<2.8
6.1
<20
<5
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 ail per month? ❑ yes ❑ no (if yes, complete Part 13)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 504
6.0 — 9.0
-
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.
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Thom Edgerton 01/31/19
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the cased "No Discharge" reports) to:
Division of Water C' lity
Attn: DWQ Central Fi es
1617 Mail Service Ce ter
227699-1617
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."
(Signat�r%f Permittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2 of 2

ElMommoM I
ANN'S HOUSE OF NUTS,INC.=STORMWATER
ATTN: RICKY COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
ID#: 72
DATE COLLECTED: 12/20/18
DATE REPORTED : 12/26/18
REVIEWED BY: /
Stormwater
Stormwater
Stormwater
Stormwater
Analvsis
Method
PARAMETERS
(l/1, Grab)
(N2, Grab)
V3, Grab)
04, Grab)
Date
Analyst
Code
PH (not to be used for reporting)
6.3
6.8
6.2
6.1
12/20/18
H IM
4500H B-II
COD, mg/l
67
62
21
<20
12/21/18
SEJ
H8000-79
Total Suspended Residue, mg/1
39
22
<2.6
<2.8
12/21/18
TCW
2540D41
TPH (1664B), mg/1
<6
<6
<5
<5
12/21/18
SEJ
EPA1664B

Environment I, Inc. CHAIN OF CUSTODY RECORD
r: 7085. 114 Oakmont Dr. Pace I of
Greetwille \TC 77858 C
eiWiroffirnent 1 inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phnnc [phone] • Fax [phone]
Ij CHLOx[NL.
CLIENT: 72 Week: 39
pH CHECK (LAB)
Ij uv
p
p
P
G
CONTAINER TYPE. PIG
%,NN'S HOUSE OF NUTS, INC .=STORMWATER
j NONE
kTTN: RICKY COOKE
!01 EAST 3RD ST.
CHEMICAL PRESERVATION
3.0. BOX 70
A
ClA
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20BERSONVILLE NC 27871
O50
A -NONE D-NAOH
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252) 795-6500
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SAMPLE LOCATION
DATE
TIME
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CLASSIFICATION:
❑
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WASTEWATER(NPDES)
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4
❑ DRINKING WATER
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DWQIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING MENT/DELIVERY
j1I
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SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT) °C
RIS D R)
DA0TTME
RECEIVED Bltv
D ME
C�zD
COMMENTS
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RECEIVED BY (SI �
DATE/TIME
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! P14 5 Oe � 1 7, 27 Ffl / 5� 0C
RELINQUISHED BY (SIG.)
DATEITIME
RECEIVED BY (SIG.)
DATE'TIME
t,.2Sampler must place a T" for composite sample or a "G" for
tASE READ Instructions for completing this form on the reverse side. 1W._ 339189
FORM 05 - Grab sample in the blocks above for each parameter requested.

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
CERTIFICATE OF COVERAGE NO. NCG060349
FACILITY NAME Ann' House of Nuts
COUNTY Martin
PERSON COLLECTING SAMPLES Mike Speller
LABORATORY Environment 1 Lab Cert. ## 10
.I
Part A: Stormwater Benchmarks and Monitoring Results
Date submitted
RE1, ENESAMPLE COLLECTION YEAR 2018
Z��FACILITY ACTIVITIES INCLUDE (check all that apply):
�UL _ ❑ use/process meats ❑ use animal fats/byproducts
G> �I1LDI5CHARGING TO SALTWATERS? ❑YES ®NO
-f ION
PLEASE REMEMBER TO SIGN ON THE REVERSE 3
Total event rainfalP .15" or ❑ No discharge this period
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliformi,
Colonies per 100 ml
Enterococci1,
Colonies per 100 ml
Benchmark
-
100 or 50°
Within 6.0 — 9.0
120
30
1000
500
1
6/27/18
26
6.61
69
<6
_
2
6/27/18
20
7.81
407
<6
' Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no (ifyes. complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 504
6.0 — 9.0
-
' 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.
SWU-249 Last Reprised: October 18, 2012
Page 1 of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
+ 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Thom Edgerton
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of
monitoring -period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617 ji
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
7—),3-(�
(Date)
Additional copies of this form may be downloaded at: http://portal,ncdenr.org/web/wq/ws/su/npdessw##tab-4
$ %k: U-249
Last Reprised: October 18, 2012
Page 2 of 2

ULI��LJ L`.'J13illJlJi�L�JULI� �� LIEiL:��lE [�V�ial� r' ltJ -
• -Wa�Eorratex "IDr10 :� 1'�
RO, BOX 7015, 114 OAKMONT DRIVE 'PI-InN� [phone]
I 'GREENVIE.LE, N.C. 27835-7085 FAX 25,`'2) 7�i6.-063;3
3
ID$: 72
ANN'S HOUSE OF NUTS,INC.=STORMWATER
ATTN: RICKX COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
PARAIIF?' TRS
I'll (nul to be used for reporting)
COD, mg/I
Total Suspended Residue, ulgll
11111 (166411), mgll
DATE COLLECTED: 06/27/18
DATE REPORTED 07/02/18
REVIEWED BY:
Slormivater
Storluwaler
Analysis
Method
(1l1, Grab)
(1l2. Crab)
URIC
Analyst
Code
6.7
6.5
06/28/18
11MM
45001113-11
69
407
06/29/18
SEJ
118000-79
26
20
0612948
BIT
254OD-11
<6
<6
06129/18
SGI
EPA166413

Ent-ironraent 1, Inc.. CHAIN OF CUSTODY RECORD
P.O. Box 70S5. 114 Oakmont Dr. Pa-e 1 of
Oreem-ille, `C'7S58 `
en v i ranm;-m I i nc.com
Phone (2521`'56-6208 • Fax [phone]
tat S I N FECTI O\
CHLORME: NEUTRALIZED AT COUECTION
CHLORINE
[�
pH C.HEC!( (L S)
C.LIE N T 72 1
UV
P
P
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G
CONTAINER TYPE. PtG
MMN'S HOUSE OF 1NLrrS,1\C.=SfOK,N1WATER
NONE
MIN'. R1CKY COOKE
!01 EAST 3RD ST.
CHEMIC.ALPRESERVATION
P.O. BOX 70
A
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ROBERSOIN ILLE NC 27871
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DURING SHIPMENT;DELIVERY
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SAMPLES COI LECTEI7 BY:
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PLEASE.READ Instructions for cornpieting this form on the reverse side.
FOR.+! +!5
Sampler must place a -C- for composite sample or a `G" for No 338007
Grab sample in the blocks move for each parameter requested.

H
A P;Iw)
Stormwater Discharge Outfall (SDD)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: r a e k -
Permit No.: NICIGI or rtificate of Coverage No.:
Facility Name: 11rpi 5
County: &VA 14 r h Phone No. 212-795—&S49D
Inspector:
Date of Inspection: b y
Time of Inspection:
Total Event Precipitation (inches): . /15-�''
Was this a "Representative Storm Event" or "Measureable Storm invent" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or'measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
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.
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 DWQ Regional Offlce.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description: _ J
Outfall No. l Structure (pipe, 'tch, etc.) r j�
Receiving Stream: SAOA -ram
Describe the inIdustrial activities t occur within the outfall drainage area: Eno'p
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ T--M o '-'- L ! �f
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): L r9 b^-'P _
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
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 ® 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 No
S. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes C�N3
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, Last modified 10/25/2012

1. Outfall Description:
Outfall No. - 2 Structure (pipet ditch, etc.) Rio
Receiving Stream:
Describe„the/industrial activities that occur within the outfall drainage area:. r ,o
2. Color: Describe the color of the disch rge 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.): __4
4. 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
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 I is no solids and 5 is extremely muddy-
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes �Vo
8. Is there an oil sheen in the stormwater discharge? Yes ` Na
9. Is there evidence of erosion or deposition at the outfall? Yes 600
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. lnvesilgatlon.
Page 2 of 2
SWU-242, Last modified 10/25/2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG060349 SAMPLE COLLECTION YEAR 2018
FACILITY NAME Ann's House of Nuts FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Martin --RECEIVED ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Brian Hill JUL 3 1 z01$ DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY Environment 1 Lab Cert. # _ 10
CE_1'd 9 t<j-\L �1noNl
�31PJrZ 0i
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
•
Totol event rainfall or ❑ No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100 ml
Enterococcil,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 — 9.0
120
30
1000
500
1
5/10/18
<3.1
5.71
<20
<6
2
5/10/18
<2.6
5.71
24
<5
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.
`See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no (if yes, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 504
6.0 — 9.0
-
1 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.
5WU-249 Last Revised: October 18, 2012
Page 1 of 2

*FOR PART A AND PART B MONITORING RESULTS:
A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS, SEE PERMIT PART 11 SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ®NO ❑
REGIONAL OFFICE CONTACT NAME: Thom Edgerton 1/8118
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lob results (or at end
monitoring period in the case o "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
(Date)
Additional copies of this form may be downloaded at: http:/Iportal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S)�TTJ-249
Last Revised: October 18, 2012
Page 2 of 2

ANN'S HOUSE OF NUTS,INC.=STORMWATER
ATTN: RICKY COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
3NE (252)T756-6208
FAX [phone]f33
ID#: 72
DATE COLLECTED: 05/1.0/18
DATE REPORTED : 05/21/18
REVIEWED BY:/--
--
t
5lornnvaler
5tornnv:ater
AnalysLs
Method
PARAML;MRS
(//1, crab)
(N2, Grub)
Dute
Analyst
Code
PH (not to be used I'or reporting)
6.6
7.0
05/11/18
IIl4IM
45001111-11
C01), mg/I
<20
24
05/18/18
S J
llN000-79
Tolal Suspendccl Residue, Ing/t
<3.1
<2.6
05/14/18
JNI5
2540D-11
'11111 (166411), rug/1
<6
<5
05117/19
SI:J
ITA166411

rrrirt9r�rtii nt 1. Inc. CHAIN OF CUSTODY RECORD
P.O. Bux ?OSS. 114 Oakmont Dr. pane I of I
en v irorunent I : nc .cum
fD f SI `FECTf nN
CHLORINE NEUTRALIZED.AT COLLECT [ON
P h o n c [phone] • Fax (?52) 756-06
CHLORINE
C J_I F i': 72 Week; 1
PH CHECK (LAB)
UV
P
P
P
G
CONTAINERTYFE.P,C
ti'N'S HOUSE OF \IJTS.1NC. -STORNIWATER
NONE
.'ITN: RICKY COOKE
CHEtICALPiESERVATIDN
01 EAST 3RD ST.
.O. BOX 70
A
C
A
G
.OBERSO.VV7LLE NC 27871
A - NONE 0 - NAOH
!32) 7956500
z J
w z
=
O
UJ
� B - HN0, E - HCL
C)
7
cc
a W
w C -1H SO, F- ZINC ACETATE/NAOH
COLLECTION
w ,
�2 =
� a
tz
"
o
U
�.
W
,
G-4ATHIOSULFAi�
SAMPLE LOCATION
f)Ai cc
TIt4 E
Starmwater (N 1, Grab)
� .'G `1
ao. f
4
CL.ASSFIGAi Cft.
� �vASTE4vATEE (NEIaEsj
DPJNvJNG WATER
Starmwater (#2, Grab)
11.71
4
?z.::<
:.:#:':
>'
M
DINGr—W
1J SOUD W.STE SEC ; ON
CHAIN OF CUSTODY {SEAL) MAINTA*IED
DURING SSHH`PMENTrDi LIVERY
S.AMPILES COLLECTED BY
{p6w,- Print#
SAMPLES RECEIVED IN LAB AT ..�_`C
FE? i :OiJISHED BY (Sr.) ,S kAPLER)
JAi a` i It�`E
RECEIVED BY (SIW
rDATEMME
R-LI%dO '" ED f r8lr
DATERME
RECEIVED BY (SIG.)
D.ATET1f E
MiLa 6'
5 11.1� g:32
REUNWISHED ey tSIG.)
DATE; TIME
RECEIVED BY (SIG.)
OATErilM
PLEASE READ Instructions for Completing this forrn on the reverse Side. Sampler ,must place a "G" for composite sample 4r a "G• for FORM #5 - Grab sample in the blocks above for each parameter requested. N 2 356218

91CDEWR
Stormwater Discharge Dutfall (SDO)
. Qualitative Monitoring Report
Forguidanceonfilling out thisform,please visit. htt/portal.ncd�Lo�;/webf�Yn/ws/s�lfnpdE�4vvtah4
Permit No.:
Facility
County:
Inspect(
Date of Inspection: _
Time of Inspection: _
Total Event Precipitation (inches):
,or Certificate of Coverage No.: N _QI4/�/4/,�/�/�/
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event"or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
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.
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 DWQ Regional Office.
By this signature, I certify that th3 reeprt is accurate and complete to the best of my knowledge:
',(Signature of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. _ 1 — Structure (pipe, ditch, etc.) i IC-4
Receiving Stream: oeia#
Di
Describe the industrial activities that occur within the outfall drainage area:
L— 4- R Css4. n t)- — - —
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.): door'& -
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
l) 2 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:
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 Na
B. Is there an off sheen in the stormwater discharge? Yes l±o'
9. Is there evidence of erosion or deposition at the outfall? Yes Do
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, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 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 disc arge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: ea ✓
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): e _
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
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:
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. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes &o
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
SM-242, last modified 10/25/2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 5/24/18
CERTIFICATE OF COVERAGE NO. NCG060349 SAMPLE COLLECTION YEAR 2018
FACILITY NAME Ann's House of Nuts RECEN &CILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Martin ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES _ Michael Speller _ MAY 31 Z01bISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY Environment 1 Lab Cert. # 10 MTR Ell CC
Part A: Stormwater Benchmarks and Monitoring Results
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
>±
Total event rainfall z or ❑ No discharge this period3
Outfall°No: ;
4
Sample Collected; `
•- S rrmo/dd%yrl�
T
.T55,
'� =mg/L y-
-
pH,3SCOD,71
` �Standardiur its, �
� " r»g/L.-
0il`and Grease;;
F mg/Ur �
'Fecal`Coliform s
'Colonies per 100'ml.
w Enterococcil,
"�Colonies,per i00 ml .
Benchmark '.
*"108;or'SO4
Within 6.0_-Y9 0
120
i
- 30'
:1000
`500:..,.
1
4/7/18
54
6.8
143
<6
2
4/7/18
103
7.5
37
<6
3
4/7/18
<3.0
6.7
<20
<6
4
4/7/18
23
6.6
21
<5
1 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 awn v outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall::No. ,
Sample Collected,
} - mo/dd/yr - °
Oil.and'.`Grease,
mg/L; .
`T55,;:
-:mg/L .
pH,
'Standard units-.
Nevi Motor,;0i1°Usage,,r
Annual average-gal/mo��
Benchmark'
:. -. ~�r ..
�, 34: ;�';
100 or 50a ..
6.0 - 4:0
_
1 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 aM 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.
(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 OUTFALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Thorn Edgerton 1/8/18
Mail an original and one cry of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring_ period in the case of "No Discharge"reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information,,including the possibility of fines and imprisonment for knowing violations."
(Signature of Perm
(Datef
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wg/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012

'Efld,uT@EE mq % Immumbd
ANN'$ HOUSE OF NUTS,INC.=STORMWATER
ATTN: RICKY COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
ID#: 72
DATE COLLECTED: 04/07/18
DATE REPORTED : 04/16/18
REVIEWED BY:
Stornnvater
Stormwater
Stormwatcr
Stormwater
Analysis
Method
PARAMETERS
(#1, Grab)
(#2, Grab)
(0, Grab)
(114, Grab)
Date
Analyst
Code
P11 (not to be used For reporting)
6.8
7.5
6.7
6.6
04/09/18
HMM
450011B-11
COD, mgA
143
37
<20
21
04/13/18
SGI
118000.79
Total Suspended Residue, mg/1
54
103
<3.0
23
04/10/18
KDS
2540D-11
TP11 (166411), rngll
<6
<6
<6
<5
04/12/18
SG1
EPA I664B
a

Environment I. Inc. CHAIN OF CUSTODY RECORD
P.0. Box 7035, 114 Oakmont fir. Page I of I
6rQen%- lle. ,'JC 27858 —
c' 1 %• i rorr.nem I ine.com
D [SIN FECTION
Phone "252) 756-6208 • Fax (25_) 756-0633
CFTLORiNE
CHLORINE NEUTRALIZED AT COLLECTION
pHCHECK (LAB)
CLFENTx2 Week:13
UV
NN'S HOUSE OF 113TS,INC.=STORII1WATER
j NONE
P
I?
IP
G
I
CONTAINER TYPE, P/G
ITN: RICKY COOKE
CHEMICAL PRESERVATION
)1 EAST 3RD ST.
,O. BOX 70
t
o
C
A
C
OBERSONti'ILLE INC 27571
'n A NONE D NAOH
o
z
U
a
t-
Cn
52) 795-6500
Laa
[CO
w
z
=
B. HNOa E- HCL
Go
F •
�'LUC
0
C
- HMSO, F -ZINC ACETATEINAOH
COLLECTION
" ¢
Uj
G-NATHIOSULFATE
SAMPLFLO:ATION
DATE
TIME
a o
'w. ¢
10.
av
I
L
EG-
Storm rater #I, Grab
�- r-
�atlaq
�Q�
a
u4
�SIRCATN:
❑ WASTEWATER(NPDES)
Stormwater !!2. Grab
(��
0
(p.
4.#
=
"�"
-
'
^�,w,
vrmlYatlrl#_3, Crab}
x'
V`'`k
$
❑ DRINKINGWATER
Stormwater 04 Grab
!' !" D
3Rgj
4
DAQGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING IPMENTIDELIVERY
Y N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT
RELINQUISHED13Y(SIG. SAMPLER)
DATEMME
P, 6,111
TIJi1ME
COMMENTS-
r`
��
RE INCU!SHEJ Y (SIG.)
MIME
REC60 BY (SIG.)' 1
D E
r` -3 = •,3 b G
REL1NGUi5HED BY (SIG.)
DATEITIME
RECEIVED BY,(SIG.)
DATEMME
�J i]
PLEASE READ Instructions for completing this forma Ele reverse side. Sampler must place a "C" for composite sample or a "G" for l�l 3'4 1 1
FOSM �5 Grab sample in the blocks above for each parameter requested.

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 5/4/18
CERTIFICATE OF COVERAGE NO. NCG060349 SAMPLE COLLECTION YEAR March 2018
FACILITY NAME Ann's House of Nuts FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Martin ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY_ _ Lab Cert. t#
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
To tol event rainfall or ® No discharge this perio&
Outfall No.
Sample' Collected,
mo/dd/yr
TSS,
mg/L
pH;
Standard units
COD,
mg/L
Oil and Grease;
mg/L
Fecal Coliform',
Colonies per'100 ml
Enterococcil,
'Colonies per,100 ml
Benchmark
-
100'or 504
Within'6.0 — 9.0
120
30
}flQd { ; I V
17- D 500
MAY iI
vE
n nr C� •"f
�lA�
' 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? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease;
mg/L
TSS,
mg/L
pH,
Standard units
New -Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50"
6.0 — 9.0
-
Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at Iny 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.
(ifyes, 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 ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Thom Edgerton 1/8 18
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of
monitoring 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, 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
informatiop, including the possibility of fines and imprisonment for knowing violations."
(Sienature of Prermittee)
s-y/�
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.orp/web/wq/ws/su/npdessw#ttab-4
SWU-249 Last Revised: October 18, 2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCGO60349
FACILITY NAME Ann's House of Nuts
COUNTY Martin
PERSON COLLECTING SAMPLES Michael Seller
LABORATORY Environment 1 Lab Cert. # 10
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2018
FACILITY ACTIVITIES INCLUDE (check all that apply): RECEIVED
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES ®NO MAR 19 2018
PLEASE REMEMBER TO SIGN ON THE REVERSE 4 CENTRAL FILES
DWR SECTION
Total event rainfall' or ❑ No discharge this period'
Outfall No.
Sample Collected_ ,.
mo/dd/yr
TSS,
" mg/L . '
pH _
Standard: units'.
COD, ,..
mg/L
Oil and -Grease,:
mg/L
4: Fecal Coliforml,
Colonies per•100 ml
p Enterococci1;
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 — 9.0
;120
30
1000
S00
1
2/10/18
70
6.8
268
7
2
2/10/18
8.1
6.3
39
<5
3
2/10/18
<2.6
6.3
<20
<5
4
2/10/18
<2.6
5.9
<20
<5
i 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? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample -Collected,
Oil and Grease,
TSS,
mg/L
pH,
I Standard units
New Motor,Oil Usage,
3 Annual,average gal/mo
.Benchmark
=.
30
.100 or 504
•6.0 9.0
-
1 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.
'See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if yes, complete Part B)
SWU-249 Last Revised: October 18, 2012

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Thom Edgerton 1/8/18
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information., including the possibility of fines and imprisonment for knowing violations."
fle Sa cil'Aw!
re of Permittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/­`ws/`su/-Dpdessw#tab-4
SWU-249 Last Revised: October 18, 20I2

u
Drinking Water LOT 37715
P.0, 13OX 7085, 414 OAKMONT DRIVE `
GREENVILLE. N.C. 27835-7085
ANN'S HOUSE OF NUTS,INC.=STORMWATER
ATTN: RICICY COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
PARA1411s'I'E'RS
I'll (nol to be Wised for rel)(u-tuig)
f�(711, u1g11
C01), 111gA
Total suspended Residue, moll
TI'II (166413), mgll
PHONE'[phone]
.-FAX [phone]:33r
ID#: 72
DATE COLLECTED: 02/10/18
DATE REPORTED : 02/16/18
REVIEWED BY:
Stormn•ater
Slormwa(cr
Sto1•nnratcr
Sturmwilter
Amlvds
Method
(NI, (:ral))
(#2, Grah)
(#3, Grab)
(#4, Crab)
Date
Awdvs(
Code
6.8
6.3
6.3
5.9
02/12118
.TTII
450OH13-11
20
0211511N
SFI
118000-79
39
<20
<20
02/13/18
SE-1
118000-79
70
8.1
<2.6
<2.6
02/13/18
IWS
25401)-II
7
<5
<5
<i
02/13/18
S1:J
I?I'A166413

Envirmirm-rit I, Inc'. CHAIN OF CUSTODY RECORD
I,.r�z,� 1 u 1
Ctr�rr: illy. `:f= '7tii� � __._.
c'ilt'1rUfliTlt'.lii I in�.c•cirri
DISENI"F_t- rION
CHLORINE NEIITRA! I?�BATCQLf.ECTtQN
i- 52) 7`h-00-,-
I'hii ne S56-62W • Fax (
f
f
CHLORINE.
CLIENT:72 Week: 13
UV
�
PH. CHECK (L�SJ
P
P
P
G
I
CO 7AINERTYPE.P/G
1\'S HOUSE OF \UTS.I\C.=STOR'1IWATER
� \C)NE
.T-INN': RICKY COOKE
I
I
C IEMICALPRESERVATIQN
01 EAST 3RD ST.
'-O. BOY 70
A
C
A
C
.OBERSONNILLE tiC 27871
'c2 A - NONE D - NAOI-i
o
152) 795-6500
Lu
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i ,
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F -7INC ^CI TATE'.A(JH
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=
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G - NA i HIOSULFATE
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SAMPLE LOCATION
DATE
TIME
Stormwater (#I. Grab)
!I%�S%;
ll�-"l� �
�,j,:�
4
.:;:.
CLASSIFiCrlTION:
d%ASTEWATEP,(NPL
Stormwater (�2 Grab)
Stormwater (#3, Grab)
DRINKINGVJ.AT7=
S:ormu ater (!d. Crab)
��
.l .
�1 .A
T
L� D4'JCyr'a4V
SOLID'VASTE SECT !ON
CHAIN Of CUSTODY (SEAL) MAINTAINED
k
t
DUING S a 0h.IIENTIDELIVER'
v N
SAMPLES COECTED BY:
��L!
`
PEtC;'3SHE[
! SAMPLES RECEIVED IN LAB.-'' Q 'C
E'!tSIG.'' ,AMP! ENl`
�DAT 'TIh4w�l;'%
iV' R IG,I J7
AiETlv9c
COf�1M1ENT5:
'�Y
ELINCIG}S'r rLU "glG)
DATe=.r7WE
REGE9V D BY iSI� ,
€DAI E. i ME
=?ELIf UISHGD cYiala_1
DATETIME
R'_CEIVEp n! (`I" ;
DATEIITNIF
PLEASE READ Instructions (or completing, :his turro on the reverse Side. Sampler must place a''C° or co�Pc,si.e sam,pIa or a "G" fer 1\I p 340906
FORM =s - -- Grab samPle in the blocks above for each Parameter requested.

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit https:/Ideq.nc.gov/about/divisions /energy-mineral-land-
resources/energy-mineral-land-permits/stormwater-permits/npdes- industrial -sw#tab-4
Permit No.: N/C/G /0 /b/0 /0/tea / or Certificate of Coverage No.:
Facility Name: Ann's House of Nuts
County: Martin Phone No. 252-795-6500
Inspector: Michael Speller
Date of Inspection: 1018
Time of Inspection: 11:30 am
Total Event Precipitation (inches): 0.5
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 accurat"nd complete to the best of my knowledge:
Of sP 1,14,1sr
ignature of Permittee or Des
Pagel of 2
sWll-242, Last modified 07/28/2017

1. outfall Description:
Outfall No. I Structure (pipe, ditch, etc.) .
Receiving Stream: �u-.A,--'c2r"cR ,[reek -
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:.I %c kl� &?-«r-j
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:
1 Q 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 a) 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:
7.
E-11
1 V 3
is there any foam in the stormwater discharge?
4 5
Yes
Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of stormwater Pollution:
List and describe
DNo
No
Yes LNo
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 10/25/2012

1. Outfall Description:
Outfall No. �_ Structure (pipe, ditch, etc.) e
Receiving Stream: �fp+rf �L". o
Describe the find(ir
industrial activities that occur within the outfall drainage area: /' k
2. Color. Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ i` ter,
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): _ YO0N(;�
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
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:
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:
(9 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 o
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
5WU-242, Last modified 10/25/2012

I. Outfall Description:
Outfall No. f2 Structure (pipe, ditch, etc.) e
Receiving Stream: huI 'S,-•s-
Describe the industrial activities that occur within the outfall drainage area: Rwf nl m
2. Color: Describe the color of the dis harge using basic colors (red, brown, blue, etc,) and tint
(light, medium, dark) as descriptors: C
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): j
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
C 2 3 4 5
5. FloatingSolids: 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& 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? Yesyi
8. Is there an oil sheen in the stormwater discharge? Yes 0
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 clarlty, 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 10/25/2012

I. Outfall Description:
Outfall No. Structure (pipe, ditch, etc.) e-
Receiving Stream: Rc". ""-
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,
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:
b2 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:
P 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
B. 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
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 10/25/2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 3/6/18
CERTIFICATE OF COVERAGE NO. NCG060349 SAMPLE COLLECTION YEAR 2018
rT' r I
FACILITY NAME Ann's House of Nuts RECr—RACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Martin El use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Michael Speller MAR 0 ?D15�} HARGING TO SALTWATERS? ❑YES ®NO
LABORATORY Environment 1 Lab Cert. # 10
-f..Al i-ILE
Part A: Stormwater Benchmarks and Monitoring Results
s -
GC►�
pWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall ' or ❑ No discharge this period'
•dutfall No.
Sample Collected,
mo/dd/yr .
TSS,
mg/L-
pH,
Standard units
COD,
mg/L..
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100,ml
Enterococcil,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0-9.0
120
30'
1000
500
1
1/28/18
12
6.7
40
<6
2
1/28/18
11
7.0
32
<6
3
1/28/18
<2.8
6.3
<20
<5
4
1/28/18
<2.8
6.3
<20
<5
1 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.
'See GeQerai Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall•No.
K
Sample Collected,
and/dd/yr
Oil and Grease,
mg/L .R
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
-Benchmark.
-
30
100 or 504
6.0 —'9.0
-
1 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.
(ifyes, complete Part [3)
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 ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT -NAME: Thom Edgerton 1 $ 18
Mail an original and one copy of this DMR including all "No Discharge" re,ports within 30 days of receipt of the lab results or at end o
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signatur Permitteej
(,/-5
(Date
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wg/ws/su/n_pdessw#tab-4
SWU-249 Last Revised: October 18, 2012

is a n /1 n n it
ANN'S HOUSE OF NUTS,INC.=STORMWATER
ATTN: RICKY COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
ID#: 72
DATE COLLECTED: 01/28/18
DATE REPORTED : 02/05/18
REVIEWED BY:
Storlmvater
Storni ater
5torm4vater
Stormwaler
Analysis
Method
PARAiI E,WRS
(#1, Grab)
(#2, Grab)
(#3, Grab)
(#4, Grab)
hate Analyst
Code
I'll (not to be used for reporting)
6.7
7.0
6.3
6.3
01/29/l8
JT11
45001-IB-11
COD, mg/l
40
32
<20
<20
01/31/18
SGI
H8000-79
Total Suspended Residue, mg/1
12
11
<2.8
<2.8
01/30/18
MAR
254OD-11
I'PH (166411), mg/1
<6
<6
<5
<S
02/02/18
SM
EVAI6641B

Emin)YIflI�'ilf 1, Inc. CHAIN OF CUSTODY RECORD
Dr' Page 1 of l
rec,r,�- lIe. NC 27 SS
': n V irt, i role: i t I i ttc .cc im
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
>'htm,_ .25_ T�6-0208 Fay (_ ?) '5G-0073
CHLORINE
pH CHECK NaB)
, 72, ~ AV ek:'13UV
P
P
P
G
CONTAINER TYPE, PIG
i!;\'$ HOUSE OF NUTS, I,1'C.=STORMRi'ATER
ON`t✓
0-17N: RICKY COOKE
JA
I
CHEMICAL PRESERVATION
:01 EAST 3RD ST.
'.O. SOX 70�
A
C
C
ZOBERSOIN WILLS ,NC 27871
A NONE D NAOH
252) 795-6500
Ld
�_
,�„
cc
C7
0
`u
B - HNO, E - HCL
_
LU
o
w C - H,S0, F - ZINC ACETATE/NAOFI
COLLECTION
¢
`?
Lw -a
a
ov
C.
n.
a
w
Q G NATHIOSULFATE
SAMPLE LC'�ATION DA. z
TIME
Stormrc'ater (#1, Gr )
ab
i. (
4
''
lNi
nT>
;1111
CtA5SIF1CAT10N:
❑ WASTEWATER(NPDES)
❑ DRINKING WATER
Stormwater (#2, Grab) - I (A
N {�
5torrna ater #3 1 Gra6
I
� � V
4
a s.>
gg-
Stormwater (.44, Crab) ���
'(U
4
DWO)GW
WASTE SECTION
j
ISOLID
CHAIN OF CUSTODY (SEAL) MAINTAINED
—
DURING S MENTIDELIVERY
,
{
Y N
SAMPLES COLLECTED BY:
(Please Print)
i
SAMPLES RECEIVED IN LAB AT r °C
_ER}
REC Eli
D T-"
COMMENTS:
A -
LD�ATEIT1hiE
'RE lCUISHE]B" IGJ
DAME
.
DA ME
-- P `7.10 c 5 oG
7 r Q sr3 0Lf e
,F
JATETME
DATE(iEME
IRELNCU1SF�i_DE': (SIG.)
_
RECEIVEDBY(SIG.)
1 °��' 6 C
T_
(. PLEASE READ Instructions for comple=ing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for N 0 341417
Grab sample in the blocks above for each parameter requested.

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc.goy/about/divisions/energy-mineral-land-
resources/energy-mineral-land-permits Istormwater ermits/fides-industrial-sw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Ann's House of Nuts
County: Martin
Inspector: Michael Speller
Date of Inspection: 01128//18
Time of Inspection: 1:45
Total Event Precipitation (inches): .54
Phone No. 252-795-6500
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 o0ermittee or Designee)
Pagel of 2
SWU-242, Last modified 07/28/2017

1. Outfall Description: 1 f
Outfall No. / Structure (pi e, ditch, etc.) pi_znL_o a cA jc, t
Receiving Stream: P
Describe the industrial activities that occur within the outfall drainage area: rue b K T,.
2. Color: Describe the color of the dischar a using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:. r! a ,a iti
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): 1„�-ej:24_
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: (5)
1 2 / 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 2 0 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 CZ) 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an off sheen in the stormwater discharge? Yes L N
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, Las[ modified 10/25/2012

I. Outfall Description:
Outfall No. 2— Structure (pipe, ditch, etc.) /?
Receiving Stream: =rzf±��� ►.�
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge sing basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C r"
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): r jzs'o��
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
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 2 (3 J 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge,'where I its no solids and 5 is extremely muddy:
1 (2/ 3 4 S
7. is there any foam in the stormwater discharge? Yes No
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
5WU-242, last modified 10/25/2012

1. Oatfall Description: I
Outfall No. K _ Structure (pipe, ditch, etc.) 0 f Q
Receiving Stream: n
Describe the industrial activities that occur within the outfall drainage area: )
2. Color: Describe the color of the disch rge 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.): _ M��..
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
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 V 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.
L� 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes Na
S. Is there an of] sheen in the stormwater discharge? Yes No
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
5WU-242, Last modified 10/25/2012

1. Outfall Description:
r/
outfall No. � Structure (pipe, ditch, etc.) /1 -G
Receiving Stream: Sw
Describe the industrial activities that occur within the outfall drainage area: A- Lne,--c t
2. Color: Describe the color of the discharge us' g basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors. C� -eA i —
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): _ A.P-L---L
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:
1 0 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 6PNo
8. Is there an oil sheen in the stormwater discharge? Yes i�
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, bast modified 10/25/2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)1 SPPP Annual Update DATA REVIEW FORM
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG060349
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: Ann's House of Nuts R
County: Martin
Phone Number: (2521 795-6500 Total no. of SDOs monitored 4 FF .
10
Outfall No. 1 CENR S � 1�e
Is this outfall currently in Tier 2 (monitored monthly)?
Yes ® No El ON
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SWU-264 - Generic Annual DMR
Last revised 5/17/2013

Additional Outfall Attachment
Outfall No. 2
Is this outfall currently in Tier 2 (monitored monthly)? Yes ® No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ® No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SWU-264 - Generic Annual DMR
Last revised 511712013

Additional Outfall Attachment
Outfall No. 3
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SWU-264 - Generic Annual DMR
Last revised 5/17/2013

Additional Outfall Attachment
Outfall No. 4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SWU-264 - Generic Annual DMR
Last revised 511712013

I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
Signature
Date
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
A_ SH_EVILLE REGIONAL OF.
2090 US Highway 70
Swannanoa, NC 28778
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
_MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
[phone]
_ _
RALEIGH REGIONAL OFFICE i WASIIIIVGTON REGIONAL OFFICE N
3800 Barrett Drive !
943 Washington Square Mall
Raleigh, NC 27609 i
Washington, NC 27889
[phone] %
[phone]
WINSTON+SALEM REGIONAL OFFICE I
CENTRAL OFFICE —
585 Waughtown Street i
1617 Mail Service Center
Winston-Salem, NC 27107
Raleigh, NC 27699-1617
-_ [phone] [
[phone] -_
OFFI
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
` ''To preserve, protect
and enhance
Nol h Carolina's ivater..."
SWU-264 - Generic Annual DMR
Last revised 511712013

February 7, 2018
NCDEQ
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Ref: Stormwater Discharge Outfall Annual Summary Report
To whom it may concern:
Enclosed are two copies of the 2017 Stormwater Discharge Outfall Annual Summary Report for Ann's
House of Nuts, 201 E. 3rd Street, Robersonville, NC 27871.
Regards,
John Forestell
Sr. EHS Specialist
Ann's House of Nuts
201 E. 3rd Street
Robersonville, NC 27871

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit htttp deg nc.gov/about/divisions/energy-mineral-land-
resources/energy-mineral-land-permits/stormwater-permits/npdes-industrial-sw#tab-4
Permit No.: N/C/G /0 /6/0/0 /0 /0/ or Certificate of Coverage No.:
Facility Name: Ann's House of Nuts
County: Martin Phone No.[phone]
Inspector: Brian Hill
Date of Inspection: 12/20/14__
Time of Inspection: 2:05 PM
Total Event Precipitation (inches): 0.25 Jq
_ N3U2018
All permits require qualitative monitoring to be performed during a "measVM le�storXn 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 certif hat this report is accurate and complete to the best of my knowledge:
(Signature of P6-rx ttee or Designee
Page 1 of 2
SWU-242, Last modified 07/28/2017

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 1/23/18
CERTIFICATE OF COVERAGE NO. NCG060349 SAMPLE COLLECTION YEAR 2017
FACILITY NAME Ann's House of Nuts FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Martin ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Brian Hill DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY Environment 1 Lab Cert. # 10
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall' 0.25" or ❑ No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100 ml
..Enterococcix,
'Colonies per 100 ml
Benchmark
-
100 or 50'
Within 6.0 — 9.0
120
30
1000
S00
1
12/20/17
30
6.6
142
<5
N/A
N/A
2
12/20/17
44
7.0
129
<5
N/A
N/A
3
12/20/17
8.5
6.2
<20
<5
N/A
N/A
4
12/20/17
<2.6
6.1
<20
<5
N/A
N/A
1 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? ❑ yes ® no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L _
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo.
'Benchmark
-
30
100 or 504
6.0 -- 9.0
-
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 anv outfalls, you must still submit this discharge monitoring report with a checkmark here.
45ee General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(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 ATTHE 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. Thom Edgerton, Washington Regional Office
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of
monitoring period in the case of "No Discharge" 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."
c� 2,�( _ j
v,
(Signature of P&nittee)
j (T51 1 %
(D te)
Additional copies of this form may be downloaded at: http1/portal.ncdenr.org/web/wg/wsZsu/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012

EArgREM % hm
TOW
P.O. BOX 7085,114 OAKMONT DRIVE
___GREENVILLE,_N'.C. 27835-7085
ANN'S HOUSE OF NUTS,INC.=STORMWATER
ATTN: RICKY COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
F, X,[phone] +
ID#: 72
DATE COLLECTED: 12/20/17
DATE REPORTED : 12/26/17
REVIEWED BY: '+ ;
Stormwater
Stormwater
Stormwater
Stornmater
Analysis
Method
PARAI4E'rERS
(#l, Grab)
(#2, Grab)
03. Grab)
(#4, Grab)
Date Analyst
Code
PH (not to be used for reporting)
6.6
7.0
6.2
6.1
KN1R
4500HB-1 E
COD, mgll
142
129
<20
<20
12/26/17
SEJ
H8000-79
Total Suspended Residue, mgll
30
44
8.5
<2.6
12/21/17
KAC
254OD-11
TPH (166413), mgll
<5
<5
<5
<5
12/21/17
SEJ
EPA1664B

'Environment [,Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr. Page I of I
Greenville, NC 27858
environment I inc.com
DISINFECTION
CHLORINENEUTRALIZEDATCOLLECTION
Phone (25'') 75fi-6208 •Fax [phone]
Ij CWE_OR[NE
CLIENT: 72 Week: 13
Ij UV
pH CHECK (LAB)
P
P
P
G
CONTAINER TYPE, PIG
►NN'S 1101USE OF NUTS,INC.=STORRIWATER
j ,NO,NF
1 TN: RICKY COOKE
CHEMICAL PRESERVATION
M1 EAST 3RD ST.
�
1.0. BOX 70
A
C
A
C
tOBERSONVILLE NC 27871
m o
A - NONE D - NAOH
252) 795-65011
LLT
z '�
w
LU
B - HNO3 E - HCL
0p
_
Ld
cCo
wLU
z
p
e
C- H2SO, F- ZINC ACETATE/NAOH
COLLECTION
w
<
C
a-
cc G- NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
o
►2 a
totc
UU
H
F�
a
Sturmwater (#I, Crab)
z�
4
>'
....
CLASSIFICATION:
WASTEWATER(NPDES)
Stormwater (#2, Grab)
�,
2; '`
4:"
:...
5iorunvater (#3, Crab)
�j
�• raj
l -�
4Q
_
DRINKING WATER
Storinwater (#4, Crab)
?' �(✓
Z-LiJ
j
4
;...
DWQIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING SHIPMENT/DELIVERY
Y N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT P 3 °C
ISHED BY (S1 {SAMP ER)
DATEfTIME
RECEIVED BY (SIG.)
DATER IME
COMMENTS:
REL4N
L
RELINQUISHED BY (SIG
DATEITIME
RECEIVED BY }
DATE/TIME
i7 Z.3A,
Z� 33r
OEU�NQUISHED
BY (SIG.)
DATEMME
RECEIVED BY (S .)
DATE/TIME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for N 0 341416
FORM #s Grab sample in the blocks above for each parameter requested.

1. Outfall Description: f
Outfall No. Structure (pipe, ditch, etc. � 7 .
Receiving Stream:
Describe Peindustrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge uTn asic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: t `1` r C'j
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): _ &4aln'-e
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 U 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 CV 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 i 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
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, Last modified 10/25/2012

I. Outfall Description:
Outfall No. Structu a ipe, 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: L i
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): _.9 _
4. 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
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 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 23 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes Gp
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, Last modified 10/25/2012

1. Outfall Description:
Outfall No. __s Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: ' r
2. Color: Describe the color of the disc arge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ . r,
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: e5"�
1J 2 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:
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:
7
8.
CT) 2 3
Is there any foam in the stormwater discharge?
4 5
Yes
Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall?
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
D "
SWU-242, Last modified 10/25/2012

I. Outfall Description:
Outfall No.� Structure (pipe, ditch, etc.) -�
Receiving Stream: -j
Describe the industrial activities that occur within the outfall drainage area: ' K
2. Color: Describe the color of the disc4rge 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.):
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
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/ 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 No
8. Is there an oil sheen in the stormwater discharge? Yes No
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
SVVU-242, Last modified 10/25/2012

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit https-..Z./deg.nc.gov/about/divisions/energy-mineral-land-
resougeslenergy-mineral-Iand-permits,Ltormwater-permits/npdes-industrial-sw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Ann's House of Nuts
County: Martin Phone No. 252)795-6500
Inspector: Michael Speller
Date of Inspection: 11 `19 17
Time of Inspection: 06:30am
Total Event Precipitation (inches): 0.12
AN232018
i1W,")
All permits require qualitative monitoring to be perform] cMptirtg:aL` l�le�surable storm event."
�O. "'PSSING UNIT
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^ertify that this report is accurate and complete to the best of my knowledge:
(Signatj
11V
Permittee dDesignee)
Pagel of 2
SwU-242, Last modified 07/28/2017

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted i 8 18
CERTIFICATE OF COVERAGE NO. NCG060349 SAMPLE COLLECTION YEAR 2017
FACILITY NAME Ann's House of Nuts FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Martin ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Michael Speller DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY Environment 1 Lab Cert. # 10
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall' or ❑ No discharge this period'
%06tfAl'No.
Sa6iple Collected,
Amb/dd/yr
TSS,
" mg/c
pH,
Standard'units
COD, .
mg/L
Oil and Grease, .
mg/L
Fecal Coliforml,
Colonies per 100 ml
EnterococciF,.
Colonies per 100 ml
-Benchmark
�... ` -
�100 or SW
Within'6.0 -'9.0
120 '"
30'
1000 '
5o0
1
11/19/17
20
6.9
50
<5
N/A
N/A
2
11/19/17
17
6.6
641
8
N/A
N/A
3
11/19/17
4.8
6.5
24
<5
N/A
N/A
4
11/19/17
<2.7
6.3
21
<5
N/A
N/A
1 Only applies to facilities that use/process meats.
2 The total precipitation must be recorded using data from an on -site rain gauge.
s For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ® no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
- •,Outfall-No.
-Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L'
TSS,
mg/L
pH,
Standard units,.:,
New�Motor'Oil Usage,
Annual average gal/mo
BenchiiiarK
30
100 or
6.0 - 9.0
-
1 Only applies to facilities that use/process meats.
z The total precipitation must be recorded using data from an on -site rain gauge.
s 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.
(ifyes, 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 ATTHE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES 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: Thom Edgerton, Washington Regional Office
Mail an original and one copy of this DMR, including all "No Discharge,' reports, within 30 days_ of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, includin,Ae possibility of fines and imprisonment for knowing violations."
11 l'-1
(Signature of (er ittee)
01 ki
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wqLwsLsu/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012

ERW'0F@1mgm(W % hm
Moo
R.O. BOX 7085, 114 OAKMONT DRIVE PHONE [phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
ANN'S HOUSE OF NUTS,INC.=STORKWATER
ATTN: RICKY COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
ID#: 72
DATE COLLECTED: 11/19/17
DATE REPORTED : 11/27/17
REVIEWED BY:
Stormwater
Stormwater
Stormwater
Stormwater
Analysis
Method
PARAMETERS
(#l, Grab)
(#2, Grab)
(#3, Grab)
(#4, Grab)
Date
Anatyst
Code
PH (not to be used for reporting)
6.9
6.6
6.5
6.3
11/20/17
KDS
4500HB-11
COD, mg/l
50
641
24
21
11/22/17
SEJ
H8000-79
Total Suspended Residue, mg/1
20
17
4.8
<2.7
11/21/17
AKS
254OD-1 t
TPH (1664B), mg/l
<5
8
<5
<5
11/22/17
SEJ
EPA1664B

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr. Page I of 1
Greenville. NC 27858
environment] inc-corn
DISINFECTION'
.
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
CHLORINE
Lj
CLIENT: 72 Week: 39
Ij UV
pH CHECK (LAB)
p
p
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G
CONTAINER TYPE, PIG
kNNIS HOUSE OF NUTS,INC.=STORMWATER
IjNONE
ATTN: RICKY COOKE
JA
CHEMICAL PRESERVATION
d01 EAST 3RD ST.
P.O. BOX 70
A
C
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ROBERSONVILLE NC 27871
A - NONE D - NAOH
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SAMPLE LOCATION
DATE
TIME
Stormwater (#1, Grab)
i
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4
=
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CLASSIFICATION:
❑ WASTEWATER (NPDES)
Stormwater (#2, Grab)
I
:5D
4
_
Stormwater (0, Grab)
4
�30
4
DRINKING WATER
Stormwater (#4, Grab)
I
•&I0/
4
DWOIGW
LiSOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
QURINPMENT/QELIVERY
N
SAMPLES COLLECTED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT -C
RELINQUISHED BY (SIG.) (SAMPLER)
DATEMME
RECEIV Y (SIG.)
ATE/IIME
I,
COMMENTS:
1i
5 f
RELINQUISHED BY (SIG.)
DATEfrTME
RECE D BY (5
DATEMME
- C
F' �i f,? v /
Y Z pi//f ,
'- 7G i p
/�
"4 ' PK = �I �5 �j ' P Z�.
RELINQUISHED BY (SIG.)
DATEff1ME
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
FORM A5 Grab sample in the blocks above for each parameter requested. N2 344013

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 BYTHIS LABORATORYAS PER NORTH CAROLINA REGULATORY CODE.
1) Samples not falling within the required guidelines will treed to be re -collected. The client will he 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 it 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 of6C or less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough timc 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 there
is a temperature drop from the time ofcollection 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 nil. 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 ol'this firm.
4) Chlorine Neutralization. Sonic 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 ('line of collection belore 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 Colilbrms (which have
Thiosultatc in the bottles shipped Irom 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 perlortned.
5) A "C" for Composite Sample or a "G" for Grab Sarnple should be placed in the box Ibr 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 ininrrnation lelt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Colif'orm and Enterococci samples have a holding time of'6 hours from time of collection to time ofanalysis. 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.
1301), Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and M13AS 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. I f 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.

I. Outfall Description:
Outfall No. _ I Structure (pipe, itch, etc.) Cd L 2
Receiving Stream:
Describe tie iIrAi-�%
ustrial activities that occur within the outfall drainage area: ��
2. Color: Describe the color of the dischareing basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: iT , - JW2 ,
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:
1 0 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 CV 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 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/deposltlon
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
5WU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 2. Structure (pipe, ditch, etc.) _ a a -A'
Receiving Stream: 74-`-L , 5, ..a-c, — 4
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the dischar sin sic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ ��j /`vc_J _
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:
1 2 3 5) 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 2 0 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 0 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? � No
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, last modified 10/25/2012

1. Outfall Description:
Outfall No. Structure (pipe, it h, etc.) !
Receiving Stream: _ , e ,, �-Ls
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the dischar a using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ e A-
f
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): _^ I —A-421-9.
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
(i) 2 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:
(T 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:
(D 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
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, Last modified 10/25/2012

I. Outfall D scription: 1�
Outfall No. — Structur (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the ditch rge 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.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy: O
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where I its no solids and 5 is the surface covered with floating solids:
/'1 / 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. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes CN
oo
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, Last modified 10/25/2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 11/27/16
CERTIFICATE OF COVERAGE NO. NCG060349 RECEIVED
FACILITY NAME: Ann's House of Nuts
COUNTY: Martin DEC 01 2017
PERSON COLLECTING SAMPLES: Matt Modlin CENITRAL FILES
LABORATORY: Environment 1 Lab Cert. # 10 DwR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR: 2017
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' or ❑ No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100 ml
Enterococcil,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0-9.0
120
30
1000
500
1
10/24/17
191
6.2
138
<6
2
10/24/17
87
7.0
446
<6
3
10/24/17
10
6.8
58
<5
4
10/24/17
4.5
1 6.4
1 23
<5
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 month? ❑ yes ®no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfali. No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 504
6.0 — 9.0
-
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
Page 1 of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
11/27/17
Additional copies of this form may be downloaded at: httpf/portal.ncdenr.org/web/wct/ws/su/npdessw#tab-4
SWU-249
Last Revised: October 18, 2012
Page 2 of 2

ENAT(MERM Flo kw
TOW
P.O. BOX 7085, 114 OAKMONT DRIVE PHONE [phone]
GREENVILLE, N.C. 27835-7085 FAX [phone]
ANN'S HOUSE OF NUTS,INC.=STORMWATER
ATTN: RICKY COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
ID#: 72
DATE COLLECTED: 10/24/17
DATE REPORTED : 10/27/17
REVIEWED BY: /�
Stormwater
Stormwater
Stormwater
Stormwater
Analvsis
Method
PARAMETERS
(//1, Grab)
(i12, Grab)
(t13, Grab)
(#4, Grab)
Date
Analyst
Code
PH (not to be used for reporting)
6.2
7.0
6.8
6.4
10/24/17
BNC
4500HB-11
COD, mg/1
138
446
58
23
10/27/17
SEJ
H8000-79
Total Suspended Residue, mg/l
191
87
10
4.5
10/25/17
MAR
2540D-11
TPH (166413), mg/l
<6
<6
<5
<5
10/26/17
SEJ
EPA1664B

Environment 1, Inc. CHAIN OF CUSTODY RECORD
P.O. Box 7085, 114 Oakmont Dr, Page I of I
Greenville. NC 27858
environment) inc.com
DISINFECTION
CHLORINE NEUTRALIZED AT COLLECTION
Phone [phone] • Fax [phone]
CHLORINE
CLIENT:72 Week:13
UV
&a
pHCHECK (LAB)
P
1'
P
G
CONTAINER TYPE, PIG
,,NN'S HOUSE OF NUTS,INC.=STOR,1iWATER
❑ NONE
,TTN: RICKY COOK'.`.
01 EAST 3RD ST.
CHEMICAL PRESERVATION
.O. BOX 70
A
C
A
C
.OBERSONVILLE NC 27871
A -NONE D-NAOH
z
CE o
U
F--
CIO
152) 795-6500
z U
Z
w
_ B- HNO, E- HCL
O
0 J
_
CLrO
w
5J
Z
O
Q
LU C - H,SO, F - ZINC ACETATE/NAOH
COLLIE ON
000LLON a m¢
o
�uw �
�' �a
S
v
�,
U�-'
h
¢ G- NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
Stormwater (#1 Grab)
t�
7�°
4
CLASSIFICATION:
❑
'> €`°
=-_.-
Stormw ater (#2, Grab)
,Z
4
WASTEWATER (NPDES)
I a
vjk
Stormw•ater 03 Gran
I
- ❑ DRINKINGWATER
7�`�
:..
Stormwater 04, Grab)
4
DWQIGW
LSOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING SHIPMENTIDELIVERY
N
SAMPLES CO TED BY:
(Please Print)
SAMPLES RECEIVED IN LAB AT G S OC
RELIN UIS ED I .) ( PLEB)
, r) ATFJiiME
RECE BY (SIG.
; U D TEMME
COMMENTS:
A.
i1
L ('o
— u
'
k1_111OU19HED BY ( IG.)
D TEIIIME
RECEi ED BY (S
�Tj
DATEMME
1 —
5
1
r
J
f
DATEIIIME
DATEITIME
RELINQUISHED BY (SIG.)
RECEIVED BY (SIG.)
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
FORM #5 Grab sample in the blocks above for each parameter requested. N 2o 327004

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.
l) Samples not flailing 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. 'File 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 alter collection may not have had enough time to be chilled below 6C. In this case the
temperature at lime 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 oi'40 rill. 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 verily proper chemical preservation upon arrival in the lab and will note
this inibrmation 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 he de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosultste is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine betore the sample is poured in our bottle. Facilities using chlorine for disinfection should have it 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 ofthis form above the proper parameter. Samples such as Coliforms (which have
Thiosultate 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 fi)r 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 al I 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 term fir any samples which are not needed (example: dry upstream location)
Any other intormation Eclt to be pertinent should be included in the "Comments" section
CONS DERATIONS:
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 trimsportation, 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 Salcty Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.

MCDENR
Stormwater Discharge ®utfall (SD®)
Qualitative Monitoring Report
Forguidance on filling out this farm, please visit. -
Permit No.: 1_v/C/!�/Di/k/L)/-Q/10/-?/ or Certificate of Coverage No.: hVUW
e:VIVA
Facility Na 1
County: Phone No. Sad S00
Inspector: Nk: `ni N—Noalin _
Date of Inspection: J0- ay" 11
Time of Inspection: 1'•� 'bA A M.
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
dyes ❑ No
Please verify whether Qualitative Monitoring mustbe performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
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.
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 DWQ Regional Office.
By this signature, I certify that t4is,�egprt is accurate and complete to the best of my knowledge:
(Signature of Permittee or designee)
Page 1 of 2
5WU-242, Last modified 7/31/2013

1. Outfall Description: l] i
Outfall No. I Structure (pipe, ditch, etc.)
Receiving Stream:_ S�4�M5�
Describe the industrial activities that occur within the outfall drainage area: 5,7e- -A-1-
2. Color: Describe the color of the discharg a usin basic colors red, brown, blue, etc. and tint
(light, medium, dark) as descriptors: bfCwf-j ('0 cC lihi �rrt�
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): ci Y S
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 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 02 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 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 No
4. 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, Last madiFed 7/31/2013

1. Outfall escription: _
Outfall No. Structure (pipe, ditch, etc.) i�
Receiving Stream; F S4 ctvv► z�
Describe the industrial activities that occur within the outfall drainage area; <,er-
2. Color: Describe the color. of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: �,r C� h4 Limn
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): _ 2dof 7C.SS
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 C2) 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 0 3 4 5
7. is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
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, Last modified 7/31/2013

1. Outfall Description:
Outfall No. 3 Structure (pipe, ditch, etc.) t
Receiving Stream: �1 _ >wc-oni2_ _
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:. C.
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): o6 <-ss
4. 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
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:
( 1J 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:
C) 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
9. Is there evidence of erosion or deposition at the outfall? Yes
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, Last modified 7/31/2013

1. Outfall ascription:
Outfall No. H Structure (pipe, ditch, etc.) , PC —
Receiving Flct} 5vjc.',mQ _
Describe the industrial activities that occur within the outfall drainage area: >e
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ +c, h� 17C�Vin
3. Odor: Describe any distinct �yodors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): (�&(- le, SS
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 DZ 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 G 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where
'11iis no solids and S is extremely muddy:
1 3 4 5
7. is there any foam in the stormwater discharge? Yes No
B. is there an oil sheen in the stormwater discharge? Yes No
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.
SWU-242, Last modified 7/31/2013
Page 2 of 2
I

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG060349 SAMPLE COLLECTION YEAR: 2017
FACILITY NAME: ANN'S HOUSE OF NUTS R_C-;1[�:vIVE) FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY: MARTIN ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES: MICHAEL SPELLER JUN 22 2017 DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY: ENVIRONMENT 1 Lab Cert. # 10 CENTRAL PILES
DINR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
Total event roinfoll z or ❑ No discharge this period3
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100 ml
Enterococcil,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 —9.0
120
30
1000
S00
1
5/23/2017
10
6.6
162
<5
N/A
N/A
2
5/23/2017
32
8.9
235
<5
N/A
N/A
3
5/23/2017
<2.6
6.6
31
<5
N/A
N/A
4
5/23/2017
3.4
6.5
29
<6
N/A
N/A
1 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 outfails. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
..Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 501
6.0 — 9.0
-
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if yes, complete Part B)
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
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, jp*ding the possibility of fines and imprisonment for knowing violations."
(Signatoi a of Permi
� C� 12
(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

Mr�(�ij'� .r�� f[is
11 .r x._. .
ID#: 72
ANN'S HOUSE OF NUTS,INC.,STORUWATER
ATTN: RICKY COOKE
201 EAST 3RD ST. DATE COLLECTED: 05/23/17
P.O. BOX 70 DATE REPORTED : 05/25/17
ROBERSONVILLE ,NC 27871
REVIEWED BYs
Stornm'ater Stornmater StorniNvater Stormwater Analysis Method
PARAMETERS (#I, Grab) (#2, Grab) (N3, Grab) (N4, Grab) Date Analyst Code
PH (not to be used for reporliog) 6.6 8.9 6.6 6.5 05/23/17 KDS 4500HII-00
CUD, ingll 162 235 31 29 05/23/17 SEJ H8000-79
Total Suspended Residue, jugll 10 32 <2.6 3.4 05/24/17 KK111 2540D-97
TPH (1664B), njgll <5 <5 <5 <6 05)24117 S1 J EPA1664B

1. 111c, 01, 1 CATS YODY REC70RID
P;
i t I NC 1 7S
72 Week: 13
- , 1
I.WSINIT(
0 1 I.Cd 11,
. .
. . . . . . . . . . i
—
D 410E-1V, WLLEC TION I
ANN'S HOUSE OF NUTS,INC STORMWATER
ATTN: RICKY COOKS
j
P
P
P
G
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE NC 27871
[phone]
A
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aIN -
SMAFILL- UXATION DtvM 11141t
Stormwater (#I, Grab)
L
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Stormwater (#2, (drab)
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4IS
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Stonnwater (L3, Grab)
4
Stormwater (#4, Grab)
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F i A 1 r-t i 1. 1 F:, I t) 10 _V F-A L 'r M,"A Jvi 1 A I N, r,
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NO— 330244

t�
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit. httii:l1nortal.meIt:nr.orf=_/weblwa/ws/sii/iindessw#tab-4
Permit No.: N/L/4
Facility Name: .
County:
Inspector:
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches):
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
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.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfali No. �� Structure (pipe 4itch, etc.)
Receiving Stream: C
activities that occur wihin the outfal
area:
2. Color: Describe the color of the disch rge using bas'c calo sPred, 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.): /Q, D_(n •e
4. 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
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 (p 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 (D 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. is there an oil sheen in the stormwater discharge? Yes No
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.
tel
Page 2 of 2
SM-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. Z Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: UST
2. Color: Describe the color of the discharge usin 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.): t,. f3`f - .A
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 (3 J 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 2 (D 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:
7.
8.
9.
1 2 (D
Is there any foam in the stormwater discharge?
4 5
Yes !0
is there an oil sheen in the stormwater discharge? Yes No
Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stornnwater 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, Last modified 10/2S/2012

1. Outfall Description:
Outfall No. 3 Structure (pipe, ditch, etc.) AQ i-�
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: _C4 44 C
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:
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:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
4. Is there evidence of erosion or deposition at the outfall? Yes CNo
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
SM-242, Last modified 10/25/2012

1. Outfall Description: `
Outfall No.� Structure (pipe, ditch, etc.)
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: ' ,�s
2. Color: Describe the color of the discharg using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: � r
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:
(D 2 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:
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:
03�2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes Na
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
5WU-242, Last modified 10/25/2012

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2016
Individual NPDES Permit No. NCSLf LJL. """ or
Certificate of Coverage (COC) No. NCGE©0510E
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: Ann's House of Nuts
Phone Number: [phone]
Total no. of SDOs monitored 4
Outfall No. �1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Additional Outfall Attachment
FEB 0 1 2f11/
CENTRAL FILES
DWR SECTION
SWU-264-Generic-1 Mec2012

Outfall No. 2
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
"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
SWU-264-Generic-1 Mec2012

Additional Outfall Attachment
Outfall No. 3
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SWU-264-Generic-13Dec2012

Additional Outfall Attachment
Outfall No. 4
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
S W U-264-Gen eric-13 Dec2012

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 property 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 es and imprisonment for knowing violations."
Signature 46 ��-
Date / 97 /7
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
FAYETTEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE
i 2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
�RALEIGH REGIONAL OFFICE
WASHINGTON REGIONAL OFFICE
WII,MINGTON REGIONAL OFFICE
3900 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALEM REGIONAL OFFICE
CENTRAL OFFICE
1617 Mail Service Center
'To preserve, protect
585 Waughtown Street
Winston-Salem, NC 27107
Raleigh, NC 27699-1617
and enhance
[phone]
[phone]
North Carotina'swater..."
SW U-264-Generic-13Dec2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted l_XG Z.7-, 7A1�
CERTIFICATE OF COVERAGE NO. NCG06 0 3 5 2
FACILITY NAME S & D Coffee, 300 Concord Parkway South.
COUNTY Cabarrus
PERSON COLLECTING SAMPLES SQI DkGCNFlr"-Jl
LABORATORY rACE Arakq- cQ Lab Cert. # 3>+2
Sep'j,ce5
Part A: Stormwater Benchmarks and Monitoring Results
RECI
SAMPLE COLLECTION YEAR ZOk6 V Mn
FACILITY ACTIVITIES INCLUDE (check all that apply): DEC 2 8 2016
❑ use/process meats 0 use animal fats/byproductENTRAL FILES
DISCHARGING TO SALTWATERS? [-]YES ENO DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE --)
Total event rainfall 2 0.G or ❑ No discharge this period'
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0— 9.0
120
30
1000
Soo
SDO 001
12 O-7 E
, Q
r%r 2
ND--< 25..0
Nb S•0
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 month? ❑ yes E no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo-
Benchmark
-
30
100 or 50
6.0 — 9.0
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.
(if yes, complete Part B)
SWU-249 Last revised: October 18, 2012
Page l of 2

*FOR PART 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 0UTFALL 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 WX
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to: __.
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
12 /Z Z- icy,
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.or web/wq/ws/su/npdessw#tab-4
S W U-249
Last Revised: October 18. 2012
Page 2of2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000 RECEIVED
Date submitted 10/06/2016
CERTIFICATE OF COVERAGE NO. NCG060349
FACILITY NAME: Ann's House of Nuts
COUNTY: Martin
PERSON COLLECTING SAMPLES: Mike Speller
LABORATORY: Environment 1 Lab Cert. # 10
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2016
01T 11 201E
FACILITY ACTIVITIES INCLUDE (check all that apply): CENTRAL FILES
❑ use/process meats ❑ use animal fats/ byprt'�WasSECTION
DISCHARGING TO SALTWATERS? ❑YES ENO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall z or ❑ No discharge this period
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100 ml
EnterococciL,
Colonies per 100 ml
Benchmark
-
100 or 50'
Within 6.0 - 9.0
120
30
1000
500
1
09/01/2016
14
8.6
46
<5
2
09/01/2016
8.2
7.5
35
<5-A
3
09/01/2016
2.8
7.62
27
<5
4
09/01/2016 1
3.0
7.61
25
<6
1 Only applies to facilities that use/process meats. CENTRAL FILES
2The total precipitation must be recorded using data from an on -site rain gauge. DWR SECTION
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 ❑x no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 501
6.0 - 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.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if es complete Part B)
SWU-249 Last Revised: October 18, 2012
Palge I of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B_
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO x❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports within 30 days of rece6gt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signaore_Aft Permitt
/ O%6 I fo
(Date
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted: 3/22/16
CERTIFICATE OF COVERAGE NO. NCG060349
FACILITY NAME: ANN'S HOUSE OF NUTS
COUNTY: MARTIN
PERSON COLLECTING SAMPLES: MIKE SPELLER
LABORATORY: Environment 1 Lab Cert. 4 10
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR: 2016
�-a {{, IF _ CILITY ACTIVITIES INCLUDE (check all that apply):
RECE. V Lrj use/process meats ❑ use animal fats/byproducts
MAR 2 9 c.� .
D. $EHARGING TO SALTWATERS? ❑YES ®NO
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
Total event rainfall z or ❑ No discharge this period3
outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
'pH,
Standard units
COD, „
mg/L
Oil and Grease,
mg/L
Fecal Coliform',
Colonies per 100 mi
Enterococci=,-
Colonies per 100 ml
Benchmark .
-
100 or 50'
Within 6.0 — 9.0
120
30
1000
500 j
1
3/03/16
18
6.4
30
<5
I
2
3/03/16
7.6
6.8
75
<5
3
3/03/16
<2.9
6.3
<20
<5
4
3/03/16
<2.8
6.0
<20
<5
I
' Only applies to facilities that use/process meats.
Z The total precipitation must be recorded using data from an on -site rain gauge.
'- For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
`See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes M no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,'
mo/dd/yr
Oil and,Grebse,
mg/L .
TSS;
mg/L . .
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or.544'
6.0 — 9.0
-
1 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 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.
(if yes, complete Part 3)
SWU-249 Last Revised: October 19. 2012
Pane i of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FORTH E SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART !! SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES I -, NO 7,,
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ L
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" resorts, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn. DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signat re f Permittee)
Ag
(Date)
Additional copies of this form may be downloaded at: http://portal,ncdenr.org/web/wp/ws/su/npdessw#tab-4
SWU-249 Las[ Revised: October 18. 20!2
c - • — Pa xe 2 0.' 2

- SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted: 3/22/16
CERTIFICATE OF COVERAGE NO. NCG060349
FACILITY NAME: ANN'S. HOUSE OF NUTS
COUNTY: MARTIN
PERSON COLLECTING SAMPLES: MIKE SPELLER
LABORATORY: Environment 1 Lab Cert. #f 10
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR: 2016
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES ZNO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 2 or 17 No dischoroe this :.erica?
Ou*fallNo
.Sample Collected
TSB,
pli,
COD,'
Oil and -Grease,
Fecal Colrforma
Ente`r.bcocci'., '
rnpjdd/yr' , �_
' ` mg/.L,
,> Standard units
r t: �mg/L ;
mg/L
, Colonies pear 100 mi-
Colonies pe, Tft I-nI i
&enchmail�' r
F
1DO:or.50°
Within 6.0 —9:0
_
{} ,'.; 120 ;
~30
3000
500 h
_
1
3/03/16
18
6.4
30
<5
2
3/03/16
7.6
6.8
75
<5
I i
3
3/03/16
<2.9
6.3
<20
<5
j
4
3/03/16
<2.8
6.0
_<20
<5
i
i
Only applies to facilities that use/process meats.
The total precipitation must be recorded using data from an on -site rain gauge.
' ;or sampling periods with no discharge ate outfalls. You must still submit this discharge monitoring report with a checkmark here.
°see Ge; eral Permit text, Table 3, identifying the especially sensitive receiving'u'i ter classifications where the more protective benchmark apokes.
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: oniv for facilities averaging > 55 eal of new motor oil/month.
Outfall No
}
Sample ColEected,� •
,mb/,dd/yr .'
- Oil and,Grease, ,_
mg/.L
' -TSS t
mg/,L�-.:
pH;'-
5tandard•units
Neinw,Motor Oil Usage,
Annual average ga]/mo .;
Benetirnark
-
30
100 or.,5&,.
6.0 -9.0
1
Only applies to facilities that use/process meats.
The total precipitation must be recorded using data from an on -site rain gauge.
' =or sampling periods with no discharge at � 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.
(if Le , com131e,e Par. S)
U.-249 Las: Revised. October ! S. 20 i 2
pa�,P 1 04.- 2

'FOR PART A AND PART B MONITORING RESULTS:
A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART it SECTION B.
2 EXCEEDANCES fN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS, SEE PERNIj T PART !! S=CT!( 1N B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OL' T FALL? YES I! �O n
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES 0 NO
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR including all "No Discharge"' reports, within 30 days of receipt of the lab results or at end o
monitoring period in the case o "No Discharge" re arts to:
Division of Water Quality
Attn_ DWQ Central Files
1617 MaH Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR.ANY INFORMATION REPORTED:
"! certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of t;;e
person or persons who manage the system, or those persons directly responsible for gathering the information, the infor'ation su.b, ittee 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."
. v �
(Signat re f Permittee)
3 a-1— rc
(Da e)
Additio,nai copies of this form may be downloaded at: htt ortal.ncdenr.org/web/wq/`ws. su/"nr)dessw#tabb4
SWU- 49 - �aSevlSed. UCIOber 15. 210

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2015 +�1
Individual NPDES Permit No. NCS ❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG 0 6 0 3 4 9
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Faci?ity Name: ANN'S HOUSE OF NUTS
County: MARTIN
Phone Number: [phone]
Total no. of SDOs monitored. 4
Outfall No. 1
Is this outfali currently in Tier 2 (monitored monthly)? Yes ❑ No gl RECElviz
ED
Was this outfall ever in Tier 2 (monitored monthly) during the Past year? Yes ❑ No ZI MAR 0 7 2016
i If this outfali was in Tier 2 last year, why was monthly monitoring discontinued? C
Enough consecutive samples below benchmarks to decrease frequency ElRSE DWFILES
SECTION
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No Z
'�P ramete,.(units) --
Total
Rainfall,
inches
TSS m 1L'
9
�
pH,tStandard'g
[lnifsn
�� �� 5.
COD, iriglL
•Grease �m IL
�
,.!Benchmark
r _.
Date Sample
mmlddlyy
yN/A :'
_ ,�OO�or.564
6:0=
_. .
�*
:...
15/21/15
< 5
7.0
27
< 3
_.._
10/27/15
< 5
7.1
57
10
I
R i

Additionai Outfall Attachment
I Outfall No. 2
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No Z
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
I If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
i
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce rncn-toring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Pararneter, (units)
`
i
Total
Rainfall,
inches
TSStmg1L
-• -: -v '
pH, Standardf
- r
;lJnitS#
y.;
f'�" �
C0D,:mj1L
Z.
OiGand
G�eas'e;,mglL
�?'Benciiirlar`!c
N/A
100 'r 5�4
cr6 0
-�x
Date Sample
Collected,'
i mrmlddlyy
5121115
< 5
6.6
32
17
1
I
10/27/15
<7
7.7
201
9.3 I
-- — -
i
i
I
!------ — ------
1
I I i
i
1
SVVu-264-Ger,,cr...- .3� 2

Additional Outfali Attachment
i
Outfall No. 3
E Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the Past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
I, Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes❑i Not
Yes ❑ No ',gl .
Yes Nog
Parameter, (units) ---
Total
Rainfall,
inches
TSS.mgIL
pH"Standard .
fl
:nEts
.f,
1'
C_ O,D mg-l1_
E
.Oil'and
;Greas`e 'm9 1L
_-
{Benchmarks
" N/Ar��,
100 or 50°
6 0 �9:0 '.
"9.20
I Date Sample
Collected,
rnrnlA yy
,
5/21/15
< 5
6.8
280
I 24
---- — --
f 0127/ i 5
< 5
7.1
25
7.5
I
I i JI
SW'-'-264-Ge .eriC-'''D C%L .._

Additional Outfall Attachment
Outfall No; 4
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ❑ No IN
Yes ❑ Nog
Yes ❑ No lgl
Parameter, (units) i
Total
Rainfall,
inches
TSS-mg/l
t'.
iH, Standard
,, _
Linits,
,T ,..}�,
rF
{M
!I' COD; g1L-'
m
r a ,'4.,
'0H acid
-Greas;e, mg/L•
4
E
i ;
i
!Benchmark X.
N/A
100or'50°6
-
Or >9 0��'
�;120
Date Sample..-
Collected,
mmlddlyy
5121 /15
< 5
6.7
77
34
I
10/27/15
< 5
6.9
< 20
3.0
i TI
i
r
I
i
SWU-264-Generic

I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in acco card wit', a
syste n designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my mq.,-J,y c` ti;e ;,e,-sor,
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, c t,e
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false info :Nation
including the possibility o�es and imprisonment for knowing violations."
Signature
Date o,J
For questions, contact your local Regional; Office:
DWQ Regional Office Contact Information:
-T.
z-V1LLE REGJONALOFFICE FAYETTEVILLE REGIONAL .OFF:iCE MOOR�ESWLI;E.,fjE-Q1I 1:�L CUFF 1C1
2090 US Highway 70 225 Green Street 610 East Center Aven,.:e/Su, (e 3U,
Swannanoa, NC 28778 Systel Building Suite 714 Mooresviiie. NC 281 5' '
[phone] Fayetteville, NC 28301-5043 [phone]
[phone]
NEIGH REGIONAL_ OFFICE LWASHINGTON REGIONAL OFFICE WILMI;NGTQN�.REC10\'A O F,ICrr—u
3800 Barrett Drive 943 Washington Square Mall 127 Cardinal Drive Pzxiens;on j
Raleigh, NC 27609 Washington, NC 27889 Wilmington; NC 28403-28
[phone] [phone] [phone]
585 Waughtown Street 1617 Mail Service Center t%pse►va, protect,
Winston-Salem, NC 27107 Raleigh, NC 27699-1617 a�7el,`enli�ircef'
[phone] _ [phone] ___ Nar`ih:Carolina's water.::"
SVVJ-26-�- ic- ; _ EJec 2^"

I'w NCDI:NR
Division of Water Quality
Atln: DWQ Central FiICS
1617 Mail Service Ccntcr
Raleigh, NC 27699-1617
Date: 02/29/ 16
cc: Tim Wolf, %anc I'inckney
From: Vicki Stephens
"Title: Project Manager
'RECEIVED
MAR 01 zmb
oWRRAL FILES
SECTION
RE: Ann's House of Nuts -- !Annual Stormwater Discharge Outfall Monitoring Report 2015
Attached are two copies of the Annual Stormwater Discharge Outfall Monitoring Report for 2015. We had a change
in our staffing in the last month which contributed to the delay in sending out this report. 1 apologize for the delay.
Vicki Stephens
Project Manager
[phone]
Ann's House of Nuts
201 East 3'0 Street
Robersonville, NC 27871

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 1111T1/S RECEIVED
CERTIFICATE OF COVERAGE NO. NCG06 SAMPLE COLLECTION YEAR 20l.5' NOV 13 2Q15
FACILITY NAME AuW',i ElauSE Or NUi5 FACILITY ACTIVITIES INCLUDE (check all that apply): CFIr
RAL COUNTY-*1,44Tin1 ❑ use/process meats ❑ use animal fats/byprod cts, FILES
PERSON COLLECTING SAMPLES MIKE SPC-CL&2- DISCHARGING TO SALTWATERS? [:]YES ©NO , I % SECTION
LABORATORY EivVircwMedr 7 Lab Cert. # 7
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
N
Total event rainfall Z .� or ❑ No discharge this period3
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 — 9.0
120
30
1000
500
#
10 - 2-- IS
Z_q
7.71
r 09
+�1
F
0 7--/ 7r
4/
-�
/. /
y5-
i�0
9.3
r
3
v-17—/
45-
7.9r—
(o — f Sr
6'
0
—�--
----�-.
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? [Dyes ©no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50
6.0 — 9.0
-
2 Only applies to facilities that use/process meats.
2 The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
�+
C*
Cz
W
Omani
woman
Uwe
(if yes, complete Part B)
SWU-249 Last Revised: October 18. 2012
Page 1 of 2

r
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO Q
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy_ of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lob results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Ii / z
(Signature b"ermittee)
( ate
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
Pa--e 2 of 2

R E V J M 13 090414
To: NCDENR
Division of Water Quality
Attn: DWQ Central Filcs
1617 Mail Service Center
Raleigh, NC 27699-1617
Date: 1 1/09/ 15
Location: ANON NC, Engineering Dept.
cc: Tim Wolf, Zane Pinckney
From: Joan Baucum
Title: Engineering Manager
RE: Ann's I -louse of Nuts — Semi -Annual Storm Water Discharge Monitoring Report for the Period 07/01/2015 to
12/30/2015
Ovcrall SUMMARY
Ann's House of Nuts located in Robersonville, NC completed its' 2nd storm water discharge qualitative
monitoring event on 10/27/15, and received analytical results on 1 1/4/15. Upon review, the analytical results indicate
storm water discharged to SDO#2 exceeded the benchmark value of 120 mg/l, for COD, triggering Tier I response
actions.
Attached, please find the completed Discharge Monitoring Report for the period 07/01/2015 —
12/30/2015.
Next Steps
Tier I response actions have been initiated, including an evaluation of those impervious surfaces discharging to
SDO#2, and implementing appropriate controls to prevent recurrence. The Facility is prepared to monitor storm
water discharges during the next qualifying rain event to insure actions taken have been successful and demonstrate
compliance. Anew responsible individual has been identified at the facility to insure all stormwater monitoring
activities and facility inspections are conducted, analytical results are reviewed and discharge monitoring reports are
prepared and submitted within the 30-day timeframe.
V R,
Joan Baucum
Engineering Manager
[phone]
Ann's I -louse of Nuts
201 East 3T1 Street
Robersonville, NC 27871

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ANN'S HOUSE OF NUTS,INC.=STORKWATER
ATTN: RICKY COOKE
201 EAST 3RD ST.
P.O. BOX 70
ROBERSONVILLE ,NC 27871
PARAMETERS
I'll (not to be used for reporting)
COIL, nlg/1
Total Suspended Residue, nig/1
'rPH (166413), ing/1
PHONE; :(2,52)`-756-620a
FAX. (25') 75E-0633
ID#: 72
DATE COLLECTED: 10/27/15
DATE REPORTED : 11/04/15
REVIEWED BY:
S(oril N'ater
Stormwater
Stormivater
Storinlrater
AnalysLS
Method
(#1, Grab)
(#2, Grab)
(#3, Grab)
(#4, Grab)
Date
Analyst
Code
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7.1
6.9
10/27/15
CAIC
45001IB-00
57
201
25
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11/02/15
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118000-79
10
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10/28/.15
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SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted Zfi3 6s
CERTIFICATE OF COVERAGE NO. NCG060 .3 _7L 9
FACILITY NAME ANN rS H (JA OF Nu rS
COUNTY M/9Qnil
PERSON COLLECTING SAMPLES AV&Sl Q
LABORATORY FlyV14ollr4co✓r.1 #VcOAP Lab Cert. # f0
Part A: Stormwater Benchmarks and Monitoring Results
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 - 9.0
120
30
1000
500
51_2-IZ�f
L
z
rD
Nh
Nh
t:5 2
7
L o
n! q
n+/K
Z
3
,O
N/R
Nq
Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ©no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
30
100 or 50
6.0 — 9.0
' Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SAMPLE COLLECTION YEAR 2011'b_
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? []YES X❑NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Totol event roinfoi! 1 2 - for ❑ No discharge this period'
F"
(if vet, complete Part B)
SWU-249 Last Revised: October 18. 2012
Page I of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
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 copV of this DMR including all "No Discharge" reports, within 30 days of receipt of the lab results or at end o
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU 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."
(Signature of Permittee
17`l ,a jig -
(Date)'
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wg/ws/su/niadessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2 of 2

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on firing out this form, please visit: http://aortal.ncdenr.org/web/Ir/npdes-stormwater/
Permit No.: N/C/G/ o/ L / 0/ 3/jF/ 9/ or Certificate of Coverage No.: N/C/G/^/^/�/�/
Facility Name: AAWt, f%,rauSE of ovgza
County: 1*4A47-rN Phone No. ZS-�-- 795 — 6,S oo
Inspector: ml ke S'r,-ae-A
Date of Inspection: Slzi/ /s
Time of Inspection: 5=0_— 6 pm
Total Event Precipitation (inches): 2 • '-'�'
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
® Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative Storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
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.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Desig
Pagel of 2
SWU-242, last modified 7/31/2013

1. Outfall Description: Outfall No. Structure (pipJ e, ditch, etc.) `P 1 e * z.- S�R�+ w^ of 5fra�-
Iteceiving Stream: 6poei 04- •& --k4lh &Kf vie. c --.(-_ . Ae ck-.o_ Alr4-
Describe the industrial activities that occur within the outfall drainage area: .5 r+�
I" `Sfrn►-ft 41L41N a'Ar-VwF -Ift- L� - SFr n K. drQih "-&pr4 ,'t.-
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: e-I0 A-0-
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): Al(MJE
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
S. )bloating 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:
Q102 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:
2J 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes CNo
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 A114
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, Iasi modified 7/31/2013

REV JMB 090414
To: NCDI-,NR
Division of Water Quality
Attn: DWQ Central Piles
1617 Mail Service Center "o®
Raleigh, NC 27699-16170
Date: 07/28/ 15
Location: ANON NC, Engineering Dept.
cc: "him Wolf, %anc Pinckney GO��
From: Joan Baucum
Title: Engineering Manager
RE: Ann's House of Nuts — Semi -Annual Storm Water Discharge Monitoring Report for the Period 01/01/2015 to
06/30/2015
Overall SUMMARY
Ann's House of Nuts located in Robersonville, NC completed its' first storm water discharge qualitative
monitoring event on 5/21/15, and received analytical results on 6I4/15. During this time, the company's E1-ISS
Director left the company. As a result, the results were not immediately reviewed and the discharge monitoring
report was not submitted within the required 30-day window. In addition, field pl-I readings at each stormwater
outfall were not collected at the time of the rain event.
Upon review, the analytical results indicate storm water discharged to SDO93 exceeded the benchmark
value of 120 mg/L for COD, triggering Tier 1 response actions.
Attached, please find the completed Discharge Monitoring Report for the period 01/01/2015
06/30/2015.
Next Steps
Tier I response actions have been initiated, including an evaluation of those impervious surfaces discharging to
SDO#3, and implementing appropriate controls to prevent recurrence. The Facility is prepared to monitor storm
water discharges during the next qualifying rain event to insure actions taken have been successful and demonstrate
compliance. A new responsible individual has been identified at the facility to insure all stormwater monitoring
activities and facility inspections are conducted, analytical results are reviewed and discharge monitoring reports are
prepared and submitted within the 30-day timeframe.
V R,
Joan BaLlcufn
Engineering Manager
[phone]
Ann's House of Nuts
201 East 3" 1 Street
Robersonville, NC 27871