NCG080134_MONITORING INFO_20190118

PERMIT NO.
DOC TYPE
DOC DATE
STORMWATER DIVISION CODING SHEET
NCG PERMITS
/v C,� o o la 4-
0 HISTORICAL FILE
' <MONITORING REPORTS
❑ aat g o/ lib'
YYYYMM DD

Semi-annual Stormwater Discharge_ Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted 01/08/19
CERTIFICATE OF COVERAGE NO. NCG080134
FACILITY NAME _Pilot 58
COUNTY Northamo
PERSON COLLECTING SAMPLES R)
LABORATORY_SGS Lab Cert. # _346
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2018
SAMPLE PERIOD ❑ Jan -June ® July -Dec
REr,P 1\/En or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW [—]Trout ❑PNA
JAN 15 Z019 ❑Zero -flow [:]WaterSupply ❑SA
nOther
CENTRAL FP -ES
-DWR :3-E-f,T10N
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes x_no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (if applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
. 00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
001
12/12/18
<5.0
41.0
6.24
3 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11, 2013
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date _12/12/18 (first event sampled)
Total Event Precipitation (inches): _>0.1
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: If you report a somple value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 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�includinq all "Na Discharge" reports,_ within 317 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
2617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
// — ,y
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.orglwebJwq(ws/su/npdessw#tab-4
SWU-250 last revised April 11, 2013
Page 2 of 2

Daytoi
The results set forth herein are provided by SGS North America Inc. e-Hordcony 2.0
Automated Report
Technical Report for
Pilot Travel Centers LLC
ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
SGS Job Number: JC79686
Sampling Date: 12/12/18
Report to:
Apex Companies, LLC
7724 Garland Circle
Roanoke, VA 24019
[e-mail]
ATTN: Robert Wagner
Total number of pages in report: 14
Test results contained within this data package meet the requirements
of the National Environmental Laboratory Accreditation Program
and/or slate specific certification programs as applicable.
B n McGuire
General Manager
Client Service contact: Tammy McCloskey 732-329-0200
Certifications: NJ(12129), NY(10983), CA, CT, FL, IL, IN, KS, KY, LA, MA, MD, ME, MN, NC,
Oil VAP (CL0056), AK (UST-103), AZ (AZ0786), PA, RI, SC, TX, UT, VA, WV, DoD FLAP (ANAO 1-2248)
This report shall not be reproduced, except in Its entirety, without the written approval of SGS.
Test results relate only to samples analyzed.
SCS North America Inc. • 2235 Route 130 - Dayton, NJ 08810 - let: 732-329-0200 • fax: [phone]
SGS is the sole authority liu tiudioriying edits or ntndiiicatinirs to this document. Please share your ideas about
lJnaulhoriz,ed mi?dilicaliim ol'lhis rcl)A is strictly- prohibilvd, how we cart serve: you better au __SG9�
Rcview standard tcrnt5 at: http:ll�v�ts4.c,s.c<�rnlenitcrnt;-and-alnditions ktiS.tiS.Cu tomzr( arc isgs_c<xn
1 of 14
JC79686

Sections:
Table of Contents
Section1: Sample Summary...................................................................................................
3
Section 2: Case Narrative/Conformance Summary..............................................................
4
Section3: Summary of I1its....................................................................................................
5
Section4: Sample Results........................................................................................................
6
4.1: JC79686-1: OUTFALL 001..........................................................................................
7
Section5: Misc. Forms............................................................................................................
5.1: Chain of Custody.......................................................................
8
Section 6. General Chemistry - QC Data Summaries..........................................................
6.1: Method Blank and Spike Results Summary ..................................................................
.11.
12
6.2: Duplicate Results Summary..........................................................................................
13
6.3: Matrix Spike Results Summary.....................................................................................
14
2 of 14
_Oft,
$-
JC79686

SGS North America Inc.
Sample Summary
Pilot Travel Centers LLC
Job No: JC79686
ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
Sample Collected Matrix Client
Number Date Time By Received Code Type Sample ID
JC79686-1 12/12/18 12:45 RJ 12/13/18 AQ Water !OUWA-LL OOl
((�((��
' 3 of 44
—S-GSr-
JC73686

CASE NARRATIVE / CONFORMANCE SUMMARY
Client: Pilot Travel Centers LLC Job No JC79686
Site: ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC Report Date 12/19/2018 1:16: 15 P
On 12/13/2018, 1 Sample(s), 0 Trip Blank(s) and 0 Field Blank(s) were received at SGS North America Inc. at a maximum
corrected temperature of 2.1 C. Samples were intact and chemically preserved, unless noted below. A SGS North America Inc, Job
Number of JC79686 was assigned to the project. Laboratory sample ID, client sample ID and dates of sample collection are
detailed in the report's Results Summary Section.
Specified quality control criteria were achieved for this job except as noted below. For more information, please refer to the
analytical results and QC summary pages.
Compounds qualified as out of range in the continuing calibration summary report are acceptable as per method requirements when
there is a high bias but the sample result is non -detect.
General Chemistry By Method EPA 1664A
Matrix: AQ Batch ID: GP18047
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC79685-IDUP, JC79684-IMS were used as the QC samples for HEM Oil and Grease.
■ Matrix Spike Recovery(s) for HEM Oil and Grease are outside control limits. Spike recovery indicates possible matrix
interference,
Matrix: AQ Batch ID: GP1 m
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC79684-1MS, JC79685-1DUP were used as the QC samples for HEM Petroleum I iydrocarbons.
■ RPD(s) for Duplicate for HEM Petroleum Hydrocarbons are outside control limits for sample GP18048-D1. RPD acceptable
due to low duplicate and sample concentrations.
General Chemistry By Method SM2540 D-11
Matrix: AQ Batch 1D: GN89498
■ All samples were analyzed within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC79628-2DUP were used as the QC samples for Solids, Total Suspended,
General Chemistry By Method SM4500H+ B-11
Matrix: AQ Batch ID: R175002
■ The data for SM4500H* B-11 meets quality control requirements.
■ JC79686-1 for pH: Sample received out of holding time for pl4 analysis.
SGS North America Inc. certifies that data reported for samples received, listed on the associated custody chain or analytical task
order, were produced to specifications meeting the Quality System precision, accuracy and completeness objectives except as noted.
Estimated non-standard method measurement uncertainty data is available on request, based on quality control bias and implicit for
standard methods. Acceptable uncertainty requires tested parameter quality control data to meet method criteria.
SGS North America Inc. is not responsible for data quality assumptions if partial reports are used and recommends that this report
be used in its entirety. Data release is authorized by SGS North America Inc indicated via signature on the report cover
Wednesday, December 19, 2018 Page 1 of 1
eke% 1 4 of '14
s7L
JC79686

Summary of Hits Page 1 of l
Job Number: JC79686
Account: Pilot Travel Centers LLC
Project: ACVAR: 458, 2032 Highway 48, Pleasant Hill, NC
Collected: 12! 12/ 18
Lab Sample ID Client Sample ID Result/
Analyte Qual RL MDL Units Method
JC79686-1 OUTFALL 001
Solids, Total Suspended 41.0 4.0 mg/l SM2540 D-I1
pl-i a 6.93 su SM4500H+ 13-1 t
(a) Sample received out of holding time for pUl analysis.
—Ckf%�� 5 of 14
JC79686

Dayton,
Sample Results
Report of Analysis
Section 4
-SGSi 6of14
r
JC79606

SGS North America Inc.
Report of Analysis
Client Sample ID: OUTFALL 001
Lab Sample ID: JC79686-1 Date Sampled: 12/12/18
Matrix: AQ - Water Date Received: 12/13/18
Percent Solids: n/a
Project: ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
General Chemistry
Analyte Result
RL Units
HEM Oil and Grease < 5.0
5.0 mg/I
HEM Petroleum Hydrocarbons < 5.0
5.0 mg/I
Solids, Total Suspended 41.0
4.0 mg/I
pH a 6.93
su
(a) Sample received out of holding time for pH analysis.
RI, = Reporting Limit
Page I of l
DF Analyzed
By
Method
1 12/ 17/ 18 17:00
TM
EPA 1664A
1 12/ 17/ 18 17: 15
TM
EPA 1664A
1 12/ 14/ 18 09:51
RC
SM2540 D-1 1
1 12/ 13/ 18 15: 30
JK
SM4500H+ & 1 l
P.
J
7of14
JC79686

�GSr
Dayton
Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
Section 5
8 of 14 --_SGS—
JC79686

ra J� CHAIN OF CUSTODY
Cre N.v1M1 amr4a Y.e.. [TwNm
PAGE I OF A
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nt�iMww. gs.curJerYtemrrWcaMAlms-
JC79686: Chain of Custody
["age 1 of 2
SG9. _.
9of14
JC79686

SGS Sample Receipt Summary
Job Number: JC79686 Client: APEX COMPANIES, LLC
Date f Time Received: 12113/2018 9:30:00 AM Delivery Method:
Cooler Temps (Raw Measured) *C: Cooler 1: (2.4);
Cooler Temps (Corrected)'C: Cooler 1: (2.1);
Cooler Security Y
1, Custody Seals Present: WJ
or N
❑
Y or N
3. COG Present W ❑
2. Custody Seals Intact: FVJ
L7
4. Smpl DatesrTlme OK �]
Cooler Temperature
1. Temp criteria achieved:
Y or
�z
N
❑
2. Cooler temp verification:
IR Gun
3. Cooler media:
Ice (Bag)
4. No. Coolers:
1
Quality Control -Preservation
Y
❑
or N
R]
NIA
❑
1. Trip Blank present I coder:
2. Trip Blank listed on COC:
❑
®
❑
3. Samples preserved property:
FV]
❑
4. VOCs headspace tree:
❑
❑
Project: ACVAR: #58, 2032 HIGHWAY 48, PLEASANT HI
Airblll #'s:
Sample Integrity - Documentation
1. Sample labels present on bottles:
Y
®
or N
❑
2. Container labeling complete:
96
fl
3. Sample container label 1 COG agree:
R
fl
Sample Intearity - Condition
1. Sample recvd within HT
Y
W
or N
❑
2. All containers accounted for.
Wi
❑
3. Conditior of sample:
Intact
Sample Integrity - Instructions
1. Analysis requested is dear:
Y
2
or N NIA
❑
2. Bottles received for unspecified tests
❑
3. Sufficient volume recvd for analysis:
®
Q
4. Compositing instructions dear:
❑
❑ �J
5. Filtering instructions clear.
❑
❑
Test Strip Lot Ns: pH 1-12: 216017 pH 12+: 208717 Other: (Specify)
Comments
SM089-03
Rev, Date 12A117
JC79686: Chain oi'Custodv
Page 2 of 2
(A
i
0
—SG>9r
10 of 14
JC79686

Dayton
General Chemistry
QC Data Summaries
Includes the following where applicable:
• Method Blank and Blank Spike Summaries
• Duplicate Summaries
• Matrix Spike Summaries
Section 6
11 of 14
JC79686

METHOD BLANK AND SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC79686
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
MB Spike BSP BSP QC
Analyte Batch ID RL Result Units Amount Result %Recov Limits
HEM Oil and Grease GP18047/GN89609 5.0
HEM Petroleum Hydrocarbons GP18048/GN89610 5.0
Solids, Total Suspended GN89498 4.0
Associated Samples:
Batch GN89498: JC79686-1
Batch GPI8047: JC79686-1
Batch GP18048: JC79686-1
(') Outside of QC limits
0.0
0.0
0.0
Page 1
Mg/1 40.05 33.1 62.6 76-114%
mg/1 20.01 16.1 80.5 64-132%
mg/1
M
cc
12of14
JC79686

DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC79686
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: #56, 2032 Highway 40, Pleasant Hill, NC
QC Original DUP OC
Analyte Batch ID Sample Units Result Result RPD Limits
HEM Oil and Grease GP18047/GN89609 JC79665-1 mg/l
HEM Petroleum Hydrocarbons GP1B048/GN8961D JC79685-1 mg/1
Solids, Total Suspended GN89498 JC79628-2 mg/1
Associated Samples:
Batch GNB9498: JC79686-1
Batch GPI9047: JC79686-1
Batch GP18048: JC79686-1
(•) Outside of QC limits
(a) RPD acceptable due to low duplicate and sample concentrations.
Page 1
0.0 0.0 '0.0 - 0-10%
1.1 0.0-200.0(a) 0-34%
0.0 O.D 0.0 0-17%
c 13 of 14
_CGS�r
JC79686

MATRIX SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC79686
Account: PiLOTSS - Pilot 'gavel Centers LLC
Project: ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
QC Original Spike MS QC
Analyte Batch ID Sample Units Result Amount Result 4Rec Limits
HEM Oil and Grease GPI8047/GN89609 JC79684-1 mg/l
HEM Petroleum Hydrocarbons GP18048/GN89610 JC79684-1 mg/1
Associated Samples:
Batch GP18047: JC79686-1
Batch GPIS048: JC79686-1
(*) Outside of QC limits
(N) Matrix Spike Rec. outside of QC limits
(a) Spike recovery indicates possible matrix interference.
Page 1
4.5 40.05 33.9 :73.4N(a) 78-114%
0.0 20.01 16.5 62.5__ 64-132%
_S ccGS1 � 34of14
7C79686

July 12, 2018
Division of Water Quality
Attention: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Rh: Discharge Monitoring Report —January to ,tune 2018
Pilot #58
2032 Highway 48
Pleasant Hill, North Carolina
Permit NCGO80134
Dear Sir/Madam:
RECEi\ Fn
JUL 16 2018
CENTRAL FILES
D1NR SECTION
Attached is the January - June 2018 Discharge Monitoring Report (DMR) prepared for the above
referenced site. The laboratory analytical data for this round of sampling is also attached. If you have
any questions, please feel free to contact me at [phone].
Sincerely,
Robert S. Wagner
Program Manager
Attachments
cc: Melody Mayville, Pilot Flying J
Apex Companies, LLC • 7724 Garland Circle • Roanoke, VA 24019
T 540.563,4920 • F 540.563.4921 • apexcos.com

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 7/12/18
CERTIFICATE OF COVERAGE NO. NCGO80134
FACILITY NAME Pilot 58
COUNTY.__ Northampton
PERSON COLLECTING SAMPLES RSW
LABORATORY _SGS Lab Cert. # _346
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2018
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or Monthly Lmonth)
DISCHARGING TO CLASS ❑QRW []HQW [-]Trout []PNA
[]Zero -flow [Water.Supply [SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-ITEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0-- 9.0
001
6/29/18
6.1.
34.0
7.48
1 For sampling periods with no discharge at any single outfall, you must -still submit this discharge monitoring report with a checkmark here.
5WU-250 last revised April I I, 2013
Page I of 2

STORM EVENT CHARACTERISTICS:
Date _6/29/18 (first event sampled)
Total Event Precipitation (inches): >Q.1—
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: if you report a sample. value in excess of the benchmark, you must implement Tier 1, Tier2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART li 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 ❑
1F YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION..FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true; accurate, and complete. I am aware that
there are significant penalties for submitting.false information, including the possibility of fines and imprisonment for knowing violations."
{Sig
—%— /-'-7
(Date)
Additional copies of this form may be downloaded at: http:ljportal.ncdenr.org/weblwg/­wsIsu/npdessw#tab-4
SWU-tip last revised April I I , 2013
Page.2 of

SG-StL
r
The results sel forth herein are provided by SGS North America hic. e-11tlydcopy Z U
Automated Report
Technical Report for
Pilot Travel Centers LLC
ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
SGS Job Number: JC69205
Sampling Date: 06/29/18
Report to:
Apex Companies, LLC
7724 Garland Circle
Roanoke, VA 24019
[e-mail]
AT"TN: Robert Wagner
Total number of pages in report: 14
P
B
Test results contained within this data package meet the requirements • aul loannidis
of the National Environmental Laboratory Accreditation Program General Manager
and/or state specific certification programs as applicable.
Client Service contact: Tammy McCloskey 732-329-0200
Certifications: NJ(12t29), NY(10983), CA, CT, FL, II., IN, KS, KY, LA, MA, MD, ME, MN, NC,
OH VAP (CL0056), AK (UST-103), AZ (AZ0786), PA, Rl, SC, TX, UT, VA, WV, DoD ELAP (ANAB L2248)
This report shall not be reproduced, except In Its entirety, without the written approval of SGS.
Test results relate only to samples analyzed.
SGS North America Inc. • 2235 Route t30 • Dayton, NJ 08810 • tel: [phone] • fax: [phone]
SOS is the sole authority it)€ mithorizing edit; of nuuiif cations to this (10CLrrnZi31. Please ,hare your ideas about —���
Unaurhorized modification srl' Ihia report is strictly prohibited, how we can serve you better at:
Review standard tcrrrrs at: ht[p:1hv���v.s�s.corn'cnrtcrcn;-and-conditions l llS.4?S_C'u tixn: rl arvir;sgs.cirrn '-
1 of 14
JC69205

Sections:
Table of Contents
Section1: Sample Summary..................................................................................................
3
Section2: Case Narrative/Conformance Summary..............................................................
4
Section3: Summary of Hits....................................................................................................
5
Section4: Sample Results........................................................................................................
6
4.1: JC69205-1: OUTFALL 001..........................................................................................
7
Section5. Mise. Forms............................................................................................................
5.1. Chain of Custody...........................................................................................................
S
9
Section 6: General Chemistry - QC Data Summaries..........................................................
6.1: Method Blank and Spike Results Summary ..........
11
12
-
6.2: Duplicate Results Summary ..........................................................................................
13
6.3: Matrix Spike Results Summary ....................... ................
14
2of14
S _G �- JC69205

u
SGS North America Inc.
Sample Summary
Pilot Travel Centers LLC
Job No: JC69205
ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
Sample {Collected Matrix Client
Number Date Time By Received Code Type Sample ID
L C69205-1 1,06/29/18 12:00 RJ 07/03/18 AQ Water OUTFALFALL 06T
1
_SG9
r
3of14
Jcsezos

CASE NARRATIVE / CONFORMANCE SUMMARY
Client: Pilot Travel Centers LLC Job No JC69205
Site: ACVAR: 958, 2032 Highway 48, Pleasant Hill, NC Report Date 7/10/2018 3:07:02 PM
On 07/03/2018, 1 Sample(s), 0 Trip Blank(s) and 0 Field Blank(s) were received at SOS North America Inc, at a maximum
corrected temperature of4.7 C. Samples were intact and chemically preserved, unless noted below. A SOS North America Inc. Job
Number of JC69205 was assigned to the project. Laboratory sample ID, client sample ID and dates of sample collection are
detailed in the report's Results Summary Section.
Specified quality control criteria were achieved for this job except as noted below. For more information, please refer to the
analytical results and QC summary pages.
Compounds qualified as out of range in the continuing calibration summary report are acceptable as per method requirements when
there is a high bias but the sample result is non -detect.
General Chemistry By Method EPA 1664A
Matrix: AQ Batch ID: GP14261
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC69246-IDUP, JC69205-i MS were used as the QC samples for HEM Oil and Grease.
■ Matrix Spike Recovery(s) for HEM Oil and Grease are outside control limits. Spike recovery indicates possible matrix
interference.
i Matrix: AQ Batch ID: GP14262 I
■ All samples were prepared within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC69246-I DUP, JC69205-1 MS were used as the QC samples for HEM Petroleum Hydrocarbons.
■ Matrix Spike Recovery(s) for HEM Petroleum Hydrocarbons are outside control limits. Spike recovery indicates possible
matrix interference.
General Chemistry By Method SM2540 D-11
Matrix: AQ Batch ID: GN82353
■ All samples were analyzed within the recommended method holding time.
■ All method blanks for this batch meet method specific criteria.
■ Sample(s) JC69031-3DUP were used as the QC samples for Solids, Total Suspended.
General Chemistry By Method SM4500H+ B-11
Matrix: AQ Batch ID: R171063
■ The data for SM4500H+ B-i I meets quality control requirements.
■ JC69205-1 for pH: Sample received out of holding time for pH analysis.
SOS North America Inc. certifies that data reported for samples received, listed on the associated custody chain or analytical task
order, were produced to specifications meeting the Quality System precision, accuracy and completeness objectives except as noted.
Estimated non-standard method measurement uncertainty data is available on request, based on quality control bias and implicit for
standard methods. Acceptable uncertainty requires tested parameter quality control data to meet method criteria.
SOS North America Inc, is not responsible for data quality assumptions if partial reports are used and recommends that this report
he used in its entirety. Data release is authorized by SGS North America Inc indicated via signature on the report cover
Tuesday, July 10, 2018 Page 1 of 1
_SG' 4of14
St
JC69205

Summary of Hits Page l of 1
Job Number: JC69205
Account: Pilot Travel Centers LLC
Project: ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
Collected: 06/29/ 18
Lab Sample ID Client Sample ID Result/
Analyte Qua[ RL MDL Units Method
JC69205-1 OUTFALL 001
HEM Oil and Grease -6.1 j 4.9 mg/l EPA 1664A
Solids, "Dotal Suspended ;34.0 4.0 mg/l SM2540 D-11
pH a 7.48 su SM4500H+ 8-11
(a) Sample received out of holding time for pH analysis.
5 of 14
SGS _,
JC6B205

-S-G-S�'
Dayi
'Sample Results
Report of Analysis
Section 4
%%��
1 6 of 14
—SG
� JC69295

SGS North America Inc.
Report of Analysis
Client Sample ID: OUTFALL 001
Lab Sample ID: JC69205-1 Date Sampled: 06/29/18
Matrix: AQ - Water Date Received: 07/03/ 18
Percent Solids: n/a
Project: ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
General Chemistry
Analyte Result RL
HEM Oil and Grease 6.1 4.9
HEM Petroleum Hydrocarbons < 4.9 4.9
Solids, Total Suspended +34.0 4.0
pH a _7.48 --- !
(a) Sample received out of holding time for pH analysis.
RL = Reporting Limit
Page 1 of 1
Units
DF Analyzed
By
Method
mg/l
1 07/05/ 18 14:00
TM
EPA 1664A
mg/1
1 07/05/ 18 16:00
TM
EPA 1664A
mg/l
1 07/05/ 18 09:13
RC
SM2540 D-1
su
1 07/03/18 16:00
SUB
SM4500H+ B-II
7 of 14
S(�' Lla7_
JC69205

-S-G-S�'
Dayti
Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
Section 5
��++1 So€1a
—SGSII"_
JC69205

W �J
^� CHAIN OF CUSTODY PAGE! OF
1
'r���RY-i'aTYDSdeT.� n!'tikG.'Cl,�'L+i
1.
•1r
■
■
■
■
-IN
EDD FWWr
.�+ -
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i 10 WER �
JC69205: Chain of Custody
Page 1 of 2
1 9 of 14
_.-SGst-
JC69205

SGS Sample Receipt Summary
Job Number: JC69205 Client: APEX COMPANIES, LLC Project: ACVAR: #58. 2032 HIGHWAY 48, PLEASANT HI
Date ! Tim* Received: 71312018 10:45:00 AM Delivery Method: Alrblll # s:
Cooler Temps (Raw Measured) °C: Cooler 1: (4.7);
Cooler Temps (Corrected) °C: Cooler 1: (4.7);
Cooler security i
1. Custody Seals Present: ®
or N
❑
Y or N
3. COC Present; ❑
1. Sample labels present on bottles:
Y
®
or N
❑
2. Custody Seals Intact: R
❑
4. Smpl Oates/Time OK ® ❑
2. Container labeling complete:
R
❑
Cooler Temperature
Y or
N
3. Sample container label / COC agree:
R
❑
1. Temp criteria achieved;
WJ
❑
Sample lntearity - Condition
Y
or N
2. Cooler temp verification:
IR Gun
1. Sample recvd within HT;
❑
3. Cooler media:
Ice (Bag)
2. All containers accounted to(-
4. No. Coolers:
Quality Control
1
Y or
N
3. Condition of sample:
Intact
ftelervation
1. Trip Blank present! coder:
❑
—" NIA
❑
Sample Integrity -Instructions
1. Analysis requested is dear,
Y
or N N/A
❑
2. Trip Blank listed on COC:
❑
®
❑
2. Bottles received for unspecified tests
❑
3. Samples preserved property:
3. Sufficient volume recvd for analysis:
®
❑
4. VOCs headspace free:
[]
❑
R
4. Compositing Instructions dear:
❑
❑
5. Filtering instructions dear:
❑
❑ FVi
Test Strip Lot #s: pH 1-12: 216017 pH 12+: 208717 Other: (Specify)
Rev. Dale 12/7117
.1069205: Chain of Custody
Page 2 of 2
_SG9_
10 of 14
JCa92o5

i General Chemistry I
QC Data Summaries
Includes the following where applicable:
• Method Blank and Blank Spike Summaries
• Duplicate Summaries
• Matrix Spike Summaries
Section 6
0
11 of 14
Su -s ,- JC6B2o5

METHOD BLANK AND SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC69205
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
MB Spike BSP BSP QC
Analyte Batch ID RL Result Units Amount Result 8Recov Limits
HEM Oil and Grease GPI4261/GN82382 5.0
HEM Petroleum Hydrocarbons GP14262/GN82394 5.0
Solids, Total Suspended GN82353 4.0
Associated Samples:
Batch GN62353: JC69205-1
Batch GP14261: JC69205-1
Hatch CP14262: JC69205-1
(') outside of QC limits
0.0 mg/l
0.0 mg/l
0 :0 mg/1
Page 1
40.3 34.9 i86.6 ' 78-114%
20.13 13.5 167.1 64-132%
c 1 12 of 14
u _C ' JC69205

DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC69205
Account: PILOTSS - Pilot Travel Centers LLC
Project: ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
QC Original DUP QC
Analyte Batch ID Sample Units Result Result RPD Limits
HEM Oil and Grease
GP14261/GN82382 JC69246-1 mg/l
24.5 20.9 15.9 0-18%
HEM Petroleum Hydrocarbons
GP14262/GN82394 JC69246-1 mg/l
10.1 8.2 20.8 0-34%
Solids, Total Suspended
GNB2353 JC69031-3 mg/1
151 145 4.1 ; 0-17%
Associated Samples:
0)
Batch GNB2353: JC69205-1
tV
Batch GP14261: JC69205-1
Batch 9205-1
outside QC
(") Outside of QC limits
�
Page 1
—SG9r
13 of 14
JC69205

MATRIX SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: JC69205
Account: PILOTSS - Pilot Travel centers LLC
Project: ACVAR: #58, 2032 Highway 48, Pleasant Hill, NC
QC Original Spike MS QC
Analyte Batch 10 Sample Units Result Amount Result 4Rec Limits
HEM Oil and Grease GP14261/GN82382 JC69205-1 mg/l
HEM Petroleum Hydrocarbons GP14262/GN92394 JC69205-1 mg/1
Associated Samples:
Hatch GP14261: JC69205-1
Batch GPI4262: JC69205-1
(') Outside of QC limits
(N) Matrix Spike Rec. outside of QC limits
(a} Spike recovery indicates possible matrix interference.
Page 1
6.1 40.3 36.3 (74.9N[a) 78-114%
3.7 20,13 13.9 50.214(a) 64-132%
cc� 14 of 14
JC69205

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water QuaI ty eneral Permit No. NCG080000
Date submitted 1
CERTIFICATE OF COV RA £ NO. NC'
FACILITY NAME ('
COUNTY
PERSON COLLECT G SA IPL
LABORATORY
Comments on sample yllection or a
SAMPLE COLLECTION YEAR
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly,
(month
DISCHARGING TO CLASS R)RW ❑HQW ❑Trout ❑PNA
ero-flow —]water Supply ❑SA
❑Other
PLEASE REMEMBEIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _ o
(if yes, report your analytical results in the table immediately below) ire
Part A. Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Station and Terminals (If applicable)
Outfail
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
C
15
50_or 100 see permit
6.0 — 9.0
1 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWl t-250 tact revised April l I, 201
Pale I of 2
.'W

STORM EVENT CHARACT STICS:
Date R
t event sampled)
Total Event Precipitation (inches): ae)k
c
�J
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART 8 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 Dischar e" reports, within 30 days of receipt of the lab results or at end of monitorhIgMriod in
the case of "No Discharge_" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. ! am aware that
there are significant penaitie� for submrting false information, including the possibility of fines r,d impriscament For knowing violations."
(Date)
Additional copies of this form may be downloaded at: htt i I o=tl.t�ccler.o_el�z/ti.gjwcLu/itpciess �irtab {
SWIj-250 last revised April 11, 2013
Page 2 of 2

IDUnamls,Inc.
P.O. Box 50636, Knoxville, TN 37950
Phone: [phone] Fax: [phone]
December 17, 2015
ATTN: Central Files
Division of Water Quality
NC DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
RECEIVE[)
DEC 18 2015
CENTRAL FILeS
DWR SECT1pN
Transmitted via Federal Express #: 7752 3467 2945
RE: Discharge Monitoring Report (DMR) — Semi -Annual #2 2015
NPDES #NCG080134
Pilot Travel Center, Store #058
Pleasant Hill, NC
Dear Sir or Madam:
I have enclosed a copy of the semi-annual DMR for the second half of 2015. If you have
any questions concerning this report, or if I can be of assistance in any way please feel
free to contact me at 865-588-5422 ext. 208 or at [e-mail].
Sincerely,
Alan Fass
Environmental Manager
Dynamis, Inc.
Enclosure: One original and one copy of the semi-annual #2 2015 DMR.
cc: Joey Cupp, Environmental Manager, Pilot Travel Centers LLC, 5508 Lonas Drive,
Knoxville, TN 37909
Keith Carlton, Environmental Project Manager, Pilot Travel Centers LLC, 5508
Lonas Drive, Knoxville, TN 37909

of
t
P ^c
Stormwat.er Discharge Outfall (SDO)
(qualitative Monitoring Report
permit No.: N/C/2-/ / l I•QI l or Certificate of Cov age No.: N / /ba/11°�/
Facility Name:
County: km J4N A Phone No.
Inspector: a M- , K • s
Date of Inspection:
By this signature, I certify that this port is accurate and complete to the best of my knowledge:
(Signature ofPcirrdnee orDesigna
1, Outfall Description
Oufffill No. _ � Stru tore. (pipe ditch, etc,)
Receiving Stream: tNo�rr'a, �T
Describe the industrial a 6vities that occur within the lutfull drainage area: �•4 S _
2. Color
Describe the color of the discharge usigg bssic colors (red, brown, blue, etc.) and tint {light, medium,
dark} as descriptors: _ G I C'O'd
3, odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, +veak chlorine odor,
etc.) 'Ye7wC —
4, Clarity
Choose the number which best drscr-ibes the clarity of the discharge where 1 is clear and JO is very t
cloudy:}
/ 1/ 2 3 4 5 6 7 8 9 10
pw 1
s�vu•�x•oxmos

5, Floating Solids
i
Choose the number which best describes tht amount of floating solids in the stomiwatcr discharge where
1 is no solids and 10 is the surface covered with floating solids;
/ 1J 2 3 4 5 6 7 8 9 10
6, Suspended Solids
Choose the number which test describes the amount of suspended solids in the stormwater discharge
where I Its nno�solids and ID is extremely muddy;
{ 1/ 2 3 4 S G 7 8 9 10
7, [/Foam
Is there any Foam in the storniwater discharge? Yes No
8. Oil sheen
Is there an oil sheen In the stomwater discharge? Yes Na
9. Deposition at, Outfall
r Is there deposition of rmtedal (sediment, etc.) at or immediately below the outfall9 Yes No
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
11, 01her Obvious Indicators of Stormwater Pollution
List raid describe
Note; Low clarity, high sollds, and/or the presence of Foam, oil sheen, depasidon or erosion maybe
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU•242-020705

e-Hardcopy 2.0
Automated Report
Lafayette
ACCUTEST
L A BOA AT OR I C S
Technical Report for
Pilot Travel Centers, LLC
DYNAMTNK:Pilot #058, 2032 Highway 48, Pleasant Hill, NC
Accutest Job Number: LA14217
Sampling Date: 11/19/15
Report to:
Dynamis, Inc
P.O. Box 50636 3707 Henson Road
Knoxville, TN 37921
[e-mail]
ATTN: Emily J Wilson
Total number of pages in report: 14
�ACCRf.Q��
'Pest results contained within this data package meet the requirements Ron Benja ifll n
of the National Environmental Laboratory Accreditation Program Lab Director
and/or state specific certification programs as applicable.
Client Service contact: Ralph Frye 337-237-4775
Certifications: LDEQ(2048), LDll11(LA150012), AR(14-045-04), FL(E87657), KY(#31). NC(487), 5C(73004001),
TX(T104704186-15-7), WV(257)
This report shall not be reproduced, except in its entirety, without the written approval of Accutest Laboratories.
Test results relate only to samples analyzed.
Lafayette • 500 Ambassador Caffery • Scott, LA 70583 • tel: [phone] • hilpa/www.acculesi.com
:p 1 of 14
Accutest Laboratories is the sole authority for authorizing edits or modifications to this ACCUTG;"G
document. Unauthorized modification of this report is strictly prohibited. LA14217 �.

Sections:
Table of Contents
-1-
Section1: Sample Summary................................................................................................... 3
Section2: Summary of Hits.................................................................................................... 4
Section3: Sample Results........................................................................................................ 5
3.1: LA 14217- l : 001 ............................................................................................................ 6
Section4: Misc. Forms............................................................................................................ 7
4.1: Chain of Custody........................................................................................................... 8
Section 5: General Chemistry - QC Data Summaries.......................................................... 11
5.1: Method Blank and Spike Results Summary .................................................................. 12
5.2: Blank Spike Duplicate Results Summary ...................................................................... 13
5.3: Duplicate Results Summary .......................................................................................... 14
■❑ 2of14
v ACGUTE=ST.
LA14217 "•'"^•'•"•

Accutest Laboratories
Sample Summary
Pilot Travel Centers, LLC
Job No: LA14217
DYNAMTNK:Piiot #058, 2032 Highway 48, Pleasant Hill, NC
Sample Collected Matrix Client
Number Date Time By Received Code Type Sample ID
LA14217-1 11/19/15 08:00 11/20/15 AQ Water 001
H
■© 3of14
■.a,cMU-rES-r.
LA14217 `..... •

Summary of Hits Page 1 of 1
Job Number: LA14217
Account: Pilot Travel Centers, LLC
Project: DYNAMTNK:Pilot #058, 2032 Highway 48, Pleasant Hill, NC
Collected: 11/ 19/15
Lab Sample ID Client Sample 1D Result/
Analyte Qua] RL MDL Units Method
LA14217-1 001
Solids, Total Suspended 8.0 4.0 mg/1 SM2540 D-11
pH (Field) 6.80 su SM4500H+B-1l
C® 4of14
AMMU-rEST.

Section 3
Lafayette
M ACCUTE-=ST
L A B O R AT OR I E S
Sample Results
Report of Analysis
Cp 5of14
ACCLJTEST.
LA14217

Accutest Laboratories
Report of Analysis
Client Sample ID: 001
Lab Sample ID: LA14217-1 Date Sampled: 11/19/15
Matrix: AQ - Water Date Received: 11/20/15
Percent Solids: n/a
Project: DYNAMTNK:Pilot #058, 2032 Highway 48, Pleasant Hill, NC
General Chemistry
Analyte
HEM Oil And Grease
Solids, Total Suspended
Field Parameters
pH (Field)
RL = Reporting Limit
Page 1 of l j
Result
RL
Units
DF
Analyzed
By
Method
5.0
5.0
mg/l
1
11/24/15 09:00
cs
EPA 1664A
8.0
4.0
mg/l
1
11/24/15 09:35
Jv
SM2540 D-1I
6.80
so 1 11/19/15 08:00 SM4500H+B•I I
�I
N❑ 6of14
a ACCUTi fs-r
LA14217 "''""'"""'

Section 4
ELI Lafayette
E ACCUTES—Fe
L A ©O R AT OR I E S
Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
a
a© 7of14
0 AMMU-rEST.
LA14217 `"'"""'"""'

!_A JL" I rl
SPL, INC.
Analysis Request & Chain of Custody Record
SPL workorder No:
7 Page No.
( °�
CIerd Hams: Pilot Travel Cedar
uurmr
earns
rm
PM
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REOUESTED
ANALYSIS
Addraas. 650E Lanes Rd.
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Add— Kea. Ole. TN ZIP: 37930,0146
PhonalFax: Q66-6S&T466
Casm Ccnud: bar Cupp
EmaM:
Pmied NwmrNb PT"w
Site Name: PTC-M
S8a LocaWn: 2032 Hay.48 Placard HIL NC 27M
Invoice To: PTL-069
BWPLE ID
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DYNAWS. NIC Tad hlchsa Rd%%I- Relo CauW
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❑ sweam OC ❑ Leval 30C ❑ Level 4OC ❑ TXTRRP ❑ LA
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COOK �Y ❑N
Gcvainer Y ❑ N
❑ 241.
❑ 48 N
❑ 72 hr
INOUtSHED Y: 4
DATE:
'10&:
RECEIVED BY:
1. By sampan
2 Received By
3. By.
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4. Rscalved By. WAOi
❑ Standard 6- By, wr L A 1 J e b. -cw,- By- TO
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❑ e8M IOWGIMya Drkwe, Houaton. TX T7054 ❑ 600 Am6sfseder CsIMy N.Y-. Beta. LA 70M 459 Hughes Ddve. Tr�Ysrw Oty, AM 49M
Phm e: 000- 9-H7r6 Phone: 600.304,5227 ❑ grocer: 68&7164424
LA14217. Chain of Custody
Page 1 of 3
■® 8of14
ACCUTEST.
LA14217 ••"•• "" ••

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LA14217: Chain of Custody
Page 2 of 3
MID 9 of 14
M A,.C--MU-rEE3-r
LA14217 I .....

M�ACCUTEST. Accutest Laboratories Sample Receipt Summary
Accuteat Job Number: LA14217 Client: PILOT TRAVEL CENTER
Date 1 Time Received: 1112012015 9;20:00 AM Delivery Method:
Cooler Temps (Initial/Adjusted): #1: (1.511,41:
Cooler Security Y
1. Custody Seals Present:
or N
Y or N
3. CDC Present: Pi El
2. Custody Seals Intact: ❑
®
4, Smpl Dates/Time OK R ❑
Cooler Temperature
1, Temp criteria achieved:
Y or
[�]i
N
❑
2. Thermometer ID:
DV260;
3. Cooler media:
Ice (Bag)
4. No. Coolers:
1
Quality Control Preservation
Y or
0
N NIA
❑ ❑
1. Trip Blank present 1 cooler:
2. Trip Blank listed on COC:
❑
❑ ❑
3. Samples preserved properly:
®
❑
4. VOCs headspace free:
❑
❑ ❑
comments
Accuteat Labaratm"
V f9001304-5227
Project: PTC-058
FedEx Airblll Wa: 807901019304
a
Y or N
1. Sample labels present on bottles: ® ❑
2. Container labeling complete: ❑
3, Sample container label I CDC agree: ❑
Samole Intearity - Condition Y or N
1. Sample recvd within HT: ® ❑
2. All containers accounted for; ® ❑
3. Condition of sample: Intact
Sample Integrity - Inatructions Y or N NIA
1. Analysis requested is clear: ® ❑
2, Bottles received for unspecified tests ❑
3. Sufficient volume recvd for analysis: R1 ❑
4. Composiling instructions dear: ❑ ❑
5. Filtering instructions dear: ❑ ❑ Sa
500 Ambwsada Carrery Parkway
Scon, Liana 70583
www.acauteet cam
LA14217: Chain of Custody
Page 3 of 3
IN® 10 of 14
M ACCUTES"T:
LA14217 "'"""'"""'

Section 5
Mn Lafayette
M ACCUTEST
LABOR ATORI ES
General Chemistry
QC Data Summaries
Includes the following where applicable:
• Method Blank and Blank Spike Summaries
• Duplicate Summaries
• Matrix Spike Summaries
C❑ 11 of 14
ACCU7EBT.
LA14217 "••"'"""

METHOD BLANK AND SPIKE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: LA14217
Account: PILOTSS - Pilot Travel Centers, LLC
Project: DYNAMTNK:Pilct #056, 2032 Highway 48, Pleasant Hill, NC
MB Spike BSP BSP QC
Analyte Batch ID RL Result Units Amount Result %Recov Limits
HEM Oil And Grease GP2992/GN5536 5.0 0.0 mg/1 40 34.0 05.0 78-114% (n
Solids, Total Suspended GN5544 4.0 0.0 mg/1 1000 998 99.9 90-110% :A
Associated Samples:
Batch GN5594: LA 19217-1
Batch GP2992: LA14217-1
(+) Outside of QC limits
Page I
M■ 12 of 14
W ACCiJTEBT.
LA14217 "......""'

BLANK SPIKE DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: LA14217
Account: PILOTSS - Pilot Travel Centers, LLC
Project: DYNAMTNK:Pilot #058, 2032 Highway 48, Pleasant Hill, NC
Spike BSD QC
Analyte Batch ID Units Amount Result RPD Limit
HEM Oil And Grease GP2992/GN5536 mg/1 40 32.0 611 20%
Associated Samples:
Batch GP2992; LA14217-1
(*) Outside of QC limits
Page 1
1D 13 of 14
ACCU7eST.
LA142W `..... ""'

DUPLICATE RESULTS SUMMARY
GENERAL CHEMISTRY
Login Number: LA14217
Account: PiLOTSS - Pilot Travel Centers, LLC
Project: DYNAMTNK:Pilot 4058, 2032 Highway 40, Pleasant Hill, NC
QC Original DUP QC
Analyte Batch ID Sample Units Result Result RPD Limits
Solids, Total Suspended GN5544 LA14313-1 mg/l 550 510 7.5 0-2G%
Associated Samples:
Batch GN5544: LA14217-1
(•) Outside of QC limits
Page I
■■ 14 of 14
W ACCUTEST.
LA14217 •"••'""••

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG 8 d
FACILITY NAME I T�
COU NTY
PERSON COLL ING tAhMPLIES WAUtib Loet__
LABORATORYY e lab Cert. 6 W-3-
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR CJU SAMPLEPERIOD ®-Jan-June ❑ July -Dec
or ❑ Monthly" _ imonth)
DISCHARGING TO CLASSK]ORW ❑HQW []Trout ❑PNA
❑Zero -flow ❑Water Supply ❑5A
RECEIVED ❑Other
JUL 2 9 20
1
PLEASE REMEMBER TO SIGN ON THE REVERSE 3._
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons cde tioffeggr month? ` yes A.Ano
(if yes, report your analytical results in the table immediately below) DWR SECTION
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall
No.
Date.
Sample Collected,
mo/dd/yr
00530. _
00400....
.00556._
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (5GT-HEM), mg/L
New Motor oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
Part B. Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11. 2013
Page I of 2

STORM EVENT CHARACTERISTICS:
Date —(—Wirst event sampled)
Total Event Precipitation (inches):.
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note. If you report a sample value in excess of the benchmark, you must Implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? ' YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Moil an original and one cony of this OMR, 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, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitte --Based on my Inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submi is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significant penalties for su�rniTting f l e igfofm-41ion, inclu g the possibility of fines and imprisonment for knowing violations."
(Signature of Pe
(Date}
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wct/ws/su/npdessw#tab-4
SWU-250
last revised April 11, 2013
Page 2 of 2

,
Stormwater Discharge Outfall (SDQ)
Qualitative Monitoring Report
Permit No.: or Cartifleate of o e No.:
Facility Name:
Cou Pbone No.
Irtapector: �
Date of Inset' don:
tt
By this signatore, T certify that this report is accurate and oomplete to the best of my knowledge:
(Signature of Pi rmittoe or Designca)
1. Outfall Dweription
Outfall No. _ S itch, etc.) Ki
Receiving Stream:
06!iA29,op
•D ribe the industrial agtivitiae that accut withut autfall drainage area:
2, Color -
Describe the color of the discharge using basic col s (rod, brown, blue, etc.) and tint (light, medium,
dark) as descriptors' �i.�
Pt
3. Odor '
Describe any distinct odors that the di mV 4ve (i.e., smells strongly of fill, weals chlorine odor,
etc.)
4. Clarity
Choose the ni rnber which best describes the clarity of the discharge whore 1 is clear and 10 is very
cloudy,
/� }
1 1/ 2 3 4S 6 7 8 4 10
Page t
M-242.020705

5. Flopting Solids
Choose'the number which best describes the amount of floating solids in the stormwatta discharge where
1 is no solids and 10 is the surfacx covered with nonting solids;
1 rU2 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy;
1 �2 3 4 5 6 7 8 9 t0
7. Foam
Is there any foam in the stormwater discharge? Yes o
Is there an oil sheen In the stormwmw disdmw? Yes -ON
9. .Deposition gt Outran
is there deposition of material (sediaiemr, etc,) at or (n=ediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the autfall? Yes ((Npf
11. Other Obvious In*ators of Stormwater Pollution
Note; Low clarity, higl, solids, and/or the presence of Foam, oil sheen, deposition or erosion maybe
indicative of conditions that warrant further investigation and corrective acdor.
Page 2
SwU•242-C20703

�f
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 1 Z 131 zbl(4
CERTIFICATE OF COVERAGE NO. NCG08n_ � �
Ll
__
FACILITY NAME uo+ 1&d UbYI'4t'.i�S 4-058
COUNTY,k 4V4 O igiOld
PERSON COLLECTING SAMPLES S
LABORATORY Lab Cert. >f q _
Comments on sample collect on or analysis:
lklo 0MOPM r e&W8 acts .
SAMPLE COLLECTION YEAR Z OP
SAMPLE PERIOD ❑ Jan -June [� July -Dec
or ❑ Monthl 1 (month)
DISCHARGING JOCLASS ORW ❑HQW ❑Trout ❑PNA
RffeEIVED Zero -flow ❑Water Supply ❑SA
DEC Q:8 2014 ❑other
CENTRAL FILEPBLEASE REMEMBER TO SIGN ON THE REVERSE �
DWR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? —yes ✓o
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
No discharge this period'
L-10�u��
Date
ammo/,dd/,yrpie Col Ited
,. 0a530 � 7'0:1;
qeinrod
Total Sol dtaSssP g/Q
M7,- Oa40
5tancia d ,units
ff0055.6 a�3o
NMethod 16164nSGT H- M/+TmH�%LA.
Annual aver Oil Usa e
�r
50 r 100 see pprrn
-,_,
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
dill `, i
,No
x '` i' c' Date'
�.
-Sample Collected,
..�
�.. ;,0055fi -
No Polar OilrantltGrease%TPHEPAxMethod
• �.Y Wit.:
16fi4,(SGT HEMi, mg% : ; W
0053U "r 7 ,
Oa4U0 ...
xTotal Suspended Solids, "
i timgl
pH,
Standard units
Permct<Limit
"{"'=
s k �L.� 4
j15 'v
rs10a= permit
ago4 !se
fi R
zolyI&
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11, 2013
Page I of 2

STORM EVENT CHARACTERISTICS:
Date 106 IN. (first event sampled)
Total Event Precipitation (inches): .18
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALLTRIGGER 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, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significantperflties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
2.
1y
(Date)
itional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250 last revised April 11, 2013
Page 2 of 2

[7
W1AT��
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NCI
Facility Name:
County:
Inspector:
Date of Inspection: t
By this signatur I rtify that this
report# accurate and complete.to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description
Outfall No. . _ j96 wm dir, etc.) e
1Zecei►ring Stream: Q + G `% IO �-
- �escribe the industrial activities that occur within the outfa.l rainage area:{
PYlli�,r'.
2. Color
Describe the color of the discWge using basic colors (red. brown, blue, etc.) and tint (light, medium,
dark) as descriptors: e /-e-'j t'
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) P _
4, Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 3 4 5 6 7 8 9 10
0
SWU-242-=05

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 3 4 S 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy;
1 2 3 4 S 6 7 S 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes No
E
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes Na
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes Ij}
3
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes
11. Other Obvious Indicators of Stormwater Pollution
List and describe �/O /_`� — ram_ �JG i O G S
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective'actiorL
. Page 2
SWU-242.020705

IDYnamls,Inc,
P.O. Box 50636, Knoxville, TN 37950
Phone: [phone] Fax: [phone]
June 24, 2014
ATTN.- Central Files
Division of Water Quality
NC DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
Certified Mail #: 7013 3020 0001 4408 2878
RECEIVED
JUL U 1 2G14
CENTRAL FILES
DWQIBOG
RE: Discharge Monitoring Report (DMR) — Semi -Annual #1 2014
NPDES #NCG080134
Pilot Travel Center, Store #058
Dear Sir or Madam:
I have enclosed a copy of the semi-annual DMR for the first half of 2014. if you
have any questions concerning this report, or if 1 can be of assistance in any way
please feel free to contact me at 865-588-5422 ext. 205.
Sincerely,
Emily J. Wilson
Dynamis, Inc.
Enclosure: One original and one copy of the semi-annual #1 2014 DMR.
cc: Joey Cupp, Pilot Travel Centers, file

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted U
CERTIFICATE OF COVERAGE NO. NCG08D L 3 L1
FACILITYNAME r iOt 1OVelCeYMYS_4r©50
COUNTY �OIr�XK1 Yl
PERSON COLLE ING SAMPLES
LABORATORY Lab Cert. # EMT
Comments on sample collection or analysis:
SAMPLE COLLECTION � YEAR 2Qtq
SAMPLE PERIOD I Jan -June ❑ July -Dec
or ❑xl MontFORW
1 (month)
DISCHARGING TO CLASS ❑HQW ❑Trout ❑PNA
Zero -flow ❑Water supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes ✓no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
No discharge this period'
Outfall
Date
00530
00400
00556
No.
Sample Cohlected,
mo%dd/,yr
Total Suspended,
Solids, mg/�L
p1-1,
Standard uun�t`s-
NO Polara0il and Grease/TPH E,P.A ;
Method 1664 (SGT�H.EMj, mg/�L
New Motor Oil Usage,.
Qnnual average gal/Lmo
��
iBenchrnark
_. _
-
g50;or100�see�permit
a�.y ...
Withinj6 0�9.0
s --- •_ - _rr
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
1 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised April 11, 2013
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date (first event sampled) _
Total Event Precipitation (inches): . R.]_
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 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 receigt of the lab results (or at end of monitoring period in
the case of "No Discharge" reports) to:
Divis+on of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significant penalties fpr sub;nitting false information, including the possibility of fines and imprisonment for knowing violations."
of
tonal copies of this form may be downloaded at: http://portal.ncdenr.or weblwq/ws/su/npdessw#tab-4
S W U-250
fast revised April 11, 2013
Page 2 of 2

I
i
> _
E f P
i
F
Stormwater Discharge OutfalI (SDO)
(qualitative Monitoring Report
Permit No.: N/CI�IQf IQ/Q/OIGY or Certificate of C verage No.: NICIGIQJ 5-Loj I
Facility Name:. C 4'
3 County: Phone No. "
Inspector: a•�•. t S iar ^ ,.. t•5 .tt',. e .
Date of Inspection: S !
By this signature, I certifythatthis re ort is accurate and complete to the best of my knowledge:
i Lrt .
(Signature ofPetmittee or Designee
1, Outfall Description
Outfall No. Structure (pipe, ditch, etc.)
Receiving Stream:
..Describe the industrial activities that occur within the outfall drainage arm-
2. Color
Describe the color of the discharge wag 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.) orr
4. Clarity
t
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 3 4 5 6 7 8 9 10
Page 1
• 5W11-242-020705

1
1
,. Floating Solids
Choose the number which best describes the amount of floating solids in the storrnwater discharge where
I is no solids and 10 is the surface covered with floating solids;
2 3` 4 S 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where I is no solids and 10 is extremely muddy:
1 2 + 4 S 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes
$, Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. .Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Ye No
10. Erasion at Outfail
Is there erosion at or immediately below the outfall? Yes
11, Other Obvious Indicators of Storniwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative oi'conditions that warrant further investigation and corrective action. ,
. Page 2
SWU-242.020705