NCG100208_MONITORING INFO_20170209

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV C&
DOC TYPE
❑HISTORICAL FILE
-6. MONITORING REPORTS
DOC DATE
❑ i019 0a 001
YYYYMMDD

CERTIFIED MAIL, RETURN RECEIPT REQUESTED
Date'. 13 RECEIVED
Division of Water Quality FED 0 9 2017
Attm Central Files
1617 Mail Service Center CENTRAL FILES
Raleigh, North Carolina 27699-1617 OVVR SECTION
RE: LKQ Heavy Truck Carolina
Wilson, NC
Permit # NCG100208
2nd Semi -Annual Stormwater Discharge Outfall Monitoring Report
Dear Sir/Madam-
Please find attached the Second Semi -Annual Stormwater Discharge Outfall (SDO) Monitoring Report for the
LKQ Heavy Truck Carolina facility located in Wilson, North Carolina. This submittal covers the reporting period July
111 to December 31« 2016. Please call me at 252-360-3780 or Mr. Brandon Walsh at 615-988-3371 if you have any
comments, questions, or concerns about the information presented in this submittal.
Sincerely,
a
�reaa Raines
Plant Manager
Attachment

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE NO. NCG100208
FACILITY NAME LKQ Heavy Truck Carolina
PERSON COLLECTING SAMPLE(S) N/AREG I rE
CERTIFIED LABORATORY(S) N/A Lab N A FEB 0 9 Z017
GCNTRAL FILES
Part A: Stormwater Benchmarks and Monitoring Results QW7~. SECTION
SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory.)
COUNTY Wilson
PHONE NO. [phone]
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within
30 days of the end of that period to comply with permit reporting requirements.
Outfall
No.
Date
Sample Collected, 1
mo/dd/year
Total
Rainfall,
inches
00400
00530
----
77023
01051
78141
pH,
Standard
Units
Total Suspended
Solids (TSS),
mg/L
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), mg/L
Ethylene Glycol,
mg/L
Lead, Total
Recoverable,
mg/L
Total Toxic
Organics3,
mg/L
Benchma
-
-
6.0 — 9.01
100/502
15
8,000
(Tiers 2 and 3)
0.03
1.0
NO DISCHARGE THIS PERIOD
Note: If you report a sampled value in excesslof the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General
Permit.
ISee If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
25ee General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Form SW U-251, last revised October 25, 2012
Page 1 of 2

STORMWATER DISCHARGE QUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a waiver, the
discharger shall sign the following certification statement:
Solvent Management Plan Certification Statement
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent
management plan included in the Stormwater Pollution Prevention Plan."
rf� 5
Name (Prin n me)
Title (Print title)
3
Signature Dat
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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."
or Designee)
a/3Il7
(Date)
Form SWU-251, Last revised October25, 2012
Page 2 of 2

Wzl
L KQ
08M Recycled , 41tormortivt t+V Keystone
Certified Mail, Return Receipt Requested
July 27, 2016
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Rat_ENED
JUL 2 9 tots
CENTRAL FILES
Re: LKQ Heavy Truck Carolina DWR SECTION
Wilson, NC
Permit;# NCG100203
1' Semi -Annual Storm Water Discharge Outfall Monitoring Report
Dear Sir/Madam:
Please find the attached First Semi -Annual Storm Water Discharge Outfall (SDO) Monitoring Report for
the LKQ Heavy Truck Carolina facility located in Wilson, NC. This form is for the sample period of January
11% 2016 to June 30th, 2016. A sample was not collected during this time period as the requirements for
sample collection were not fully understood. Regular observation of the outfall during rain events did not
occur and therefore it is unknown if a discharge happened. The facility will attempt to collect two samples
during the next sample period to insure regulations are met as closely as possible. if there are any
questions or comments please do not hesitate to contact me at [phone] or LKQ's Environmental
Compliance Manager, Brandon Walsh, CPSWQ, at [phone]. The Division's understanding and
continued guidance with this matter is appreciated.
Sincerely,
Gregg Baines
Plant Manager
Attachment

CERTIFICATE OF COVERAGE NO. NCGl00208
FACILITY NAME LKQ Heavy Truck Carolina
PERSON COLLECTING SAMPLE(S) NIA
CERTIFIED LABORATORY(S) N/A Lab N A
Part A: Stormwater Benchmarks and Monitoring Results
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(This monitoring report shall be received by the Division no later than 30 days
RECEIVEDfrom the date the facility receives the sampling results from the laboratory.)
JUL 2 9 Z016 COUNTY Wilson
CENTRAL FILES PHONE NO. [phone]
DWR SECTION -
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within
30 days of the end of that period to comply with permit reporting requirements.
Outfall
No.
Date _
Sample Collected,
mo/dd/year
Total
Rainfall,
inches
00400
00530
- -
77023
01051
78141
pH,
Standard
Units
Total Suspended
Solids (TSS),
mg/L
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), mg/L'
Ethylene Glycol,
mg/L
Lead, Total
Recoverable,
mg/L
Total Toxic
Organics3,
mg/L
Benchmark
-
-
=0—
Z8,000
100/50
15
(Tiers 2 and 3)
0.03
1.0
l3 NO DISCHARGE THIS PERIOD
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General
Permit.
1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Form SWU-251, last revised October 25, 2012
Page 1 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a waiver, the
discharger shall sign the fol!owing certification statement:
Solvent Management Plan Certification Statement
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxlcorganfcs (TTO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent
management plan included in the Stormwater Poll ' n Preventio Plan."' yy
Ili
Nam Print ej
Title Prin[ title]
-7123 &
Si ature Date
Mail Original and one copy to;
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 of 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 or Designee)
(Date)
Form SWU-751, last revised October25, 2012
Page 2 of 2

CERTIFIED MAIL, RETURN RECEIPT REQUESTED
Date:
Division of Water Quality
Attn: Central Files RECEIVED
1617 Mail Service Center
Raleigh, North Carolina 27699-1617 FEB 6 2016
RE: LKQ HeavyTruck Carolina CENTRAL FILES
DWR SECTION
Wilson, NC
Permit # NCGl00208
2°d Semi -Annual Stormwater Discharge Outfall Monitoring Report
Sir/Madam:
Please find attached the 2nd Semi -Annual Stormwater Discharge Outfall (SDO) Monitoring Report for the LKQ
Heavy Truck Carolina facility located in Wilson, North Carolina. This submittal covers the reporting period July 1st to
December 316t 2015. Please call me at 252-360-3780 or Mr. Seth Ailiff of RPS GaiaTech at 404-809-3877 if you
have any comments, questions, or concerns about the information presented in this submittal.
Sincerely,
egg Baines
Plant Manager
Attachment
cc: Seth Ailiff ([e-mail])

CERTIFICATE OF COVERAGE NO. NCGIO0208
FACILITY NAME LKQ Heavy Truck Carolina
PERSON COLLECTING SAMPLE(S) N/A
CERTIFIED LABORATORY(S) N/A Lab# N A
Part A: Stormwater Benchmarks and Monitoring Results
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory.)
COUNTY Wilson
RECEIVED PHONE NO. [phone]
- C=W=WA
JUL 2 4 2015 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES
DWR SECTION
For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within
30 days of the end of that period to comply with permit reporting requirements.
Outfall
No.
Date
Sample Collected,
mo/dd/year
Total
Rainfall,
inches
00400
00530
- - - -
77023
01051
78141
pH;
Standard
Units
Total Suspended
Solids (TSS),
mg/L
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), mg/L
Ethylene Glycol,
mg/L
Lead, Total
Recoverable,
mg/L
Total Toxic
3
Organics,
mg/L
Benchmark.
-
-
1
6.0 — 9.0
2
100/50
15
8,000
(Tiers 2 and 3)
0.03
1.0
Ny ro,.L�
r
r
XA) Cow
Y00PGt2,
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General
Permit.
1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table li of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Form SWU-251, last revised October25, 2012
Page 1 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a waiver, the
discharger shall sign the following certification statement:
Solvent Management Plan Certification Statement
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TfO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent
management plan included in the Stormwater Pollution Prevention Plan."
r S
Name (Print a e)
Pl-q�� 4n� x,,
Title (P int title)
Signature Date
Mail Original and one copy to.
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 PWmittee oYdsignee)
(Date]
Form SW U-251, last revised October 25, 2012
Page 2 of 2

CERTIFIED MAIL, RETURN RECEIPT REQUESTED
July M_, 2015
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: LKQ Heavy Truck Carolina
Wilson, NC
Permit # NCGl00208
11, Semi -Annual Stormwater Discharge Outfall Monitoring Report
Sir/Madam:
Please find attached the 15, Semi -Annual Stormwater Discharge Outfall (SDO) Monitoring Report for the LKQ
Heavy Truck Carolina facility located in Wilson, North Carolina. This submittal covers the reporting period January 1s1
to June 30th 2015. Please call me at 252-360-3780 or Mr, Seth Ailiff of RPS GaiaTech at 404-809-3877 if you have
any comments, questions, or concerns about the information presented in this submittal.
Sincerely,
iregg Baines
Plant Manager
Attachment
cc: Seth Ailiff ([e-mail])

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE NO. NCGIO0208 SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
FACILITY NAME LKQ Heavy Truck Carolina
PERSON COLLECTING SAMPLE(S) N/A
CERTIFIED LABORATORY(S) IV A Lab# N A At'144.t�
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory.)
COUNTY Wilson
PHONE NO. 252 360-3780
112 PLEASE REMEMBER TO SIGN ON THE REVERSE
Part A: Stormwater Benchmarks and Monitoring Results
For sampling periods with no discharge, you must submit this discharge monitoring form noting No Flow or No Discharge within
30 days of the end of that period to comply with permit reporting requirements.
Outfall
No.
-
:
Date
Sample Collected,
V mo/dd/year =
mY
...
Total
Rainfall,
inches
d00400'-",..
00530 : a" :.
; " - - - _
77023 .'01051
_:. pH,
: -Standard
Units :
Total Suspended
Solids (TSS),
ing/L -
Non-polar
O&QTPH
(Method 1664.
SGT=HEM), mg/L
Ethylene Glycol,
mg/L
' "
Lead, Total' .
Recoverable,,'
mg/L ,: _ =
Total Toxic
3
Or ni
ga cs, F
7 mg/L
Benchmar ..
- '.
` .
:,�6.0 = 9 01 .:
100/502 F .
_ 15, _
8,000
::' (Tiers 2 and 3) , '
0 03,--
w
1A .:...,
Exempt
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General
Permit.
1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Form SWU-251, last revised October 25, 2012
Page 1 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a waiver, the
discharger shall sign the following certification statement:
Solvent Management Plan Certification Statement
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO),
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent
management plan included in the Stormwater Pollution Prevention Plan."
Name ((prin dame)
4>1
Title (Print title)
SAnatur
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
2 l�-r
Date
"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."
(Signa�6re of Permittee or Designee)
(Date)
Form SWU-251, lost revised October25, 2012
Page 2 of 2

July 7, 2014
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: LKQ Heavy Truck of Carolinas #1816
2328 Womble Brooks Road East
Wilson, NC 27893-7947
Coverage No.: NCGl00208
James Environmental
unanagenient, inc.
Certified Mail
RECEIVED
AUG 2 5 2W4
CENTRAL FILES
DWO/BOG
On behalf of LKQ Heavy Truck of Carolinas, James Environmental Management, Inc. is
submitting the enclosed Stormwater Discharge Outfall Monitoring Report and one copy for the
first semi-annual 2014 monitoring period.
Should you have any questions or require additional information, please feel free to call.
Sincerely,
�i�-�----..--.tea--
Gabby He � andez
Enc. Original Stormwater Discharge Outfall Monitoring Report and one copy
cc: Gregg Baines
600 Round Rock West Drive, Suite 201 • Round Rock, Texas 78681 • [phone] • Fax: [phone]

STORMWATER DISCHARGE.OUTFALL (SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE NO. NCG100 2 0 8
FACILITY NAME LKg Heayy Truck of Carolinas
PERSON COLLECTING SAMPLE(S) Shelia Powell
CERTIFIED LABORATORY(S) TestAmerica Pensacola Lab # 314
Lab #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory.)
COUNTY Wilson
PHONE NO.( 877 403-2129
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within
30 days of the end of that period to comply with permit reporting requirements.
Outfall
No.
Date
Sample Collected,
mo/dd/year
Total
Rainfall,
inches
00400
00530
- - - -
77023
01051
78141
pH,
Standard
Units
Total Suspended
Solids (TSSj,
mg/L
Non -polar
O&G/TPH
(Method-1664
SGT-HEM), mg/L
Ethylene Glycol,
mg/L
Lead, Total
Recoverable,
Total Toxic
Organics3,
mg/L
Benchmark
-
-
1
6.0 — 9.0
Z
1D0/50
15
8,000
(Tiers 2.and 3)
0.03
1.0
003
06/12/2014
1.0
26.3
22
3.0
1.3
0.0049
Exempt
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General
Permit.
1See If pH values outside this range are recorded in sampled storrnwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
2
See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3
For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Form SWU-251, lost revised October 25, 2012
Page 1 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a waiver, the
discharger shall sign the following certification statement:
Solvent Management Pion Certification Statement
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent management plan
included in the Stormwater Pollution Prevention Plan."
a
f3Atd�
Name (P�nbme)
TitEe rint title}
-71 ro
S gnature Date
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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."
re of lVermittee or Designee}
�7 v
(Da e)
Form SWU-251, lost revised October25, 2012
Page 2 of 2

Ak
James
if
Environmental
i.-
V
STORM WATER PROGRAM
CHAJN-OF-CUSTODY RECORD
4boA2011 CM
COWAG7.
Tamilow:
1800-672-4227
1qr EXPMTION DAM
IMPORTANT: Ship'Samples Standard -0yqMjgtfton Ice
Gm gg Baines
2128/2015
within 24 hours of'sarnpie colleclim to:
Test America Pensacola (Iab)
LKQ Heavy Truck of Carolinas
DATE IMORDERED
FROW.Ew.
2328 Womble Brooks Road
111512014
3366 McLemore DrIve
Timmw=1aftZr�
Wilson, NC 27893
Pensacola, FL 32514
it Lt(of). -33 9,?�
Samples may be rejected ffrec&Wd at ffm laboratory at a
"
L%
eboye 4*C orbeyond Me acceptable hold fte.
SAMPLE INFORMATION
PARAMETERSIMSERVATrVEfCONTAINERS
SAMPLE
M AW=
C-00MIR
FIELD
IDENTIFICATION102
aaxgc"mnXWAQ0WQ
DATE
TIME
FILTERED
(Tide Is found on the Site Map,
Tme
(Solswith PH)
pleamp
Samd
Sled
G=GftAB
yorm-
Eg. 'OuftU XMI")
TISS, 0&0*
Ethylene G",
G
N
L
N
TOW Rec. (Pb)
a
RAINFALL EVENT INFORMATION
U
Please immediately no* James Environmental Management, Inc. of
any problems regarding samples upon receipt, irraluding violation of
hold times or temperature prior to beginning the analytical process.
Please also notify us of any problems e*erienced as they occur dud ng
-N
James Environmental Management, Inc.
600 Round Rock West Ste. ON" 0
Round Rock, TX 78681
TEL (612) 244_=1 FAX (S12) 244-OM

Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NICI_I_I_l I I�l_I or Certifica e of Coverage No.: NICIGI,11 bl
Facility Name: (J: �pv T -F�t.[_[{6 (r N
County: Phone No. 2- 3 (ID -
Inspector: f-r- (� _ (IfIX-4
Date of Inspection: / ' 1 i
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Sig6ature Nf Permittee or Designee)
1. Outfall Description f f
-- Outfall No. d3 Structure (pipe, ditch, etc.)
• Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium,
dark) as descriptors:
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) f V bN7!
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 @ 7 8 9 lb
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0 S. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 12) 3 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes N�
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Other Obvious Indicators of Stormwater Pollution
List and describe
Note: Low ciarity, high solids, and/or the presence of foam or oil sheen may be indicative of pollutant
exposure. These conditions may warrant further investigation.
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