NCS000325_COMPLETE FILE - HISTORICAL_20190718

119
"`•- - STORMWATER DIVISION CODING SHEET ,-
RESCISSIONS
PERMIT NO.
� S 00 o:S/.
N
DOC TYPE
C$/�'COMPLETE FILE -HISTORICAL
DATE OF
.RESCISSION
❑ I C U � l
YYYYMMDD
f;

F E H R G RAff-IAM
ENGINEERING & ENVIRONMENTAL
UPS Tracking No. 1Z 651 395 03 5745 3088
July 11, 2019 RECEIVED
JUL 1 8 ?019
Division of Water Quality
Attention: Central Files CENTRAL FILES
1617 Mail Service Center DWR SECTION
Raleigh, North Carolina 27699-1617
Re: Storm Water Discharge Outfall (SDO) Monitoring Report - June 2019
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for June 2019.
® Please note the following:
• Storm water samples were collected during a representative storm event on
June 20, 2019.
O
a • The results for zinc are above the facility's permit benchmark for Outfall
`° No. 001 N.
• The facility has already implemented its Tier II response and will continue
monthly storm water inspections, analysis, and reporting.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
v -TALr > u_k)
Amy L. Trimble, CHMM
Environmental Scientist
ALT:dep
Enclosures
cc: Mr. Marto Carter, Patch Rubber Company (with Enclosures)
0:1Patch Rubber Compariy119-1051PA Fina1119-105 - NC Division of water Quality - 2019-07-09 -June 2019 Storm Water SDO
Report.docx
221 E. Main Street I Suite 200 I Freeport, IL 61032 1 p:815.235.7643 1 f:815.235.4632 I Fehr-graham.com
Insight, Experience. Results.

STORMWATER DISC11ARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITYNAME Patch Rubber Company
PERSON COLLECTINGSAMPLE(S) MarIn Cartpr
CERTIFIED LABORATORY(S) Meritech Lah Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
(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 Halifax
PIIONENO. 2( 52)536-2574
aREQ
ATURE OF PERMITTEE OR DESIGNEE
UIRED ON PAGE 2.
Outfall
Date
Sample
Collected
Total
Flow (if app.)
TotalNo.
Rainfall.
!1
11
1. 1 •
1 ..
. 1
1
1 1
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
50050
00556
00530
vwo
Total Flow
(if applicable)
Total
Rainfall
Oil,&& °Grease
(ifappl:)
Non -polar
O&G/TPH :.
(Method 1664.',`
SGT-HEM); if:;
appl.
Total: "
Suspended ;.
Solids
p1I
New MotorCollected
Oil Usage.
MG
inches
m
MO
m
unit
allmo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CIIARACTERISTICS:
Date 06/2012019
Total Event Precipitation (inches): 0.66
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event vas sampled)
Date
Total Event Precipitation (inclies):
Event Duration (hours): (only if applicable — see permit.)
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 prepnred 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, accurnte, and complete. I am aware that there are significant pennitics for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Date)
Form SWU-247, last revised 2/2/2012
Page 2 of 2

�C
ry_SL:k�K�
.fa5�
4�KF,
Contact: Amy Trimble
Client: Fehr Graham
221 E Main St
Freeport, IL 61032
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Report Date:
7/8/2019
NPDES #:
NCS000325
Project:
Patch Rubber Co.
Date Sample Rcvd:
6/25/2019
Meritech Work Order # 06251957 Sample: OF 001 N Grab 6/20/19
Parameters
Results .
Analysis Date
Reporting Limit
Method
COD
<15 mg/L
7/2/19
15 mg/L
EPA 410.4
Zinc, total
0.395 mg/L
6/28/19
0.010 mg/L
EPA 200.7
Meritech Work Order #
06251958 Sample: OF 002 S Grab
6/20/19
Parameters
Results
Analysis Date
Reporting Limit
Method
COD
30 mg/L
7/2/19
15 mg/L
EPA 410.4
Zinc, total
0.042 mg/L
6/28/19
0.010 mg/L
EPA 200.7
I hereby certify that I have reviewed and approve these data. ` --- XA(-),�
Laboratory Representative
642 Tanico Road, Reidsville, Nortli Carolina 27320
tel.[phone] fax.[phone]

Chain of Custody Record (COC)
77
NPDES#: N(`..SCK��a'TrJ
Client:_EerjC %.- rrL - Phone:1Sl5) 3.,�5-Wfi43
Address:._ 1 E. MQ7 n : tt Fax: (86) aW -4ia_;R
- O�fr'�rnbiG�f�hrt.�lru►�m.cor�
-rt ,- {,p o.y% Email: mca�e+-&_oa�rr_rr�DC�her. cini
j -- - Project: Ch gubiaef' CC�mt�tnv
P.O.#:
Attention: RM,4.T Turn Around Time*
How would you like your report sent? *RUSH work needs prior approval.
Circle all that apply_ mail referred) , Fax, Mail Std 10 days) 3 - 5 Da s 2d - ag Mrs
M E R ATE C H INC.
1
� �
ENVIRONMENTAL LABORATORIES
�k 642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritechiabs.com
Sample Location and/or ID #
Sampling Dates & Times
Person Taking Sample (Sign/Print):
Lab Use Only
Start
End
Comp?
Grab?
#of
Cont.
Test(s)
Required
-On Ice?
Y 5 / NO
pH OK?
Cl00
Date °
Time
Date
Time
tolz0kAR
wwf
tel7_oltg
v:4S
Gr
S] ,
OF 00a 5.
&
a
SG�
Temperature Upon
Receipt: f
IVIetF10d Of
Shipment:
* ** Dechlorination {c0.5 m of Ammonia, [ snide, Phenol and TKN samples must be done in the field prior to preservation.
Comments:
-
Compositor #
❑ UPS
Jug #
❑ Fed Ex
Are these results for regulatory purposes? Yes No .0
Report results in: mg/L 1Z mg/kg ❑ ug/L ❑
❑ Hand Delivery
Relinquished by: Da` Time:�So.�
Receive
(� `J
® Other
Relinquished / Time:
j%
Rece' y: Date: Time:
Relinqulshed b . Date: Time:
Received by Lab: r {.r a#t� i�I Time; �^� -
s_

NODENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For quidance on filling out th isform, please visit: litII2,1/portal.ncdenr.org/web/wq fws./s ltt nnde-�v#tab-I
Permit No.: or Certificate of Coverage No.: N/-C/G/—/—/—I—/—l—1
Facility Name: —Patch Patch, Rubber- Company
County: Halifax Phone No. 252-536-2574
inspector: -T i v-\ 0szn\t_1 — - -- -
Date of Inspection: to
Time of Inspection: `A ''IS Pr,n
Total Event Precipitation (inches): 0.lato" �,�k U.
Was this a 'Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
9 Yes ❑ No
Please -verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the pert -nit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
i and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
j precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office. 1
By this signature, I grtify that this report is accurate and complete to the best of my knowledge:
ture o0ermittee or Designee)
Paoe i of 2
SWU-242, Last modified 10/25/2012

— Outfall-Description:--
Outfall No. 001 _ Structure (pipe, ditch, etc.) Concrete pipe
Receiving Stream:Unnamed tributary to Roanoke River _
Describe the industrial activities that occur within the outfall drainage area:
[forth parking lot, roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: N 1 A
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): N 1
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
r 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1) 2 3 4 5
7. is there any foam in the stormwater discharge? Yes Ion
8. is there an oil sheen in the stormwater discharge? Yes N ,
9. Is there evidence of erosion or deposition at the outfall? Yes Colo
1.0. Other Obvious indicators of stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may he indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Lost modified 10/25/2012

NE
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
bbrguidance on filling out this form, please visit: htt1grir. Q w w w
Permit No.: or Certificate of Cnverage No.: N/C/G/_/_/_/,_,/_/_/
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536--2574
Inspector:
Date of Inspection:
Time of Inspection: _ A y� !00_
Total Event Precipitation (inches): Q. (0 _a" �}� L0-10
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
56 Yes ❑ No
Please verify whether Qualitative Monitoring mast be performed during a "representative storm
event" or "measureoble storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to he
performed during a "representative storm event" or during a "measureable storm event." However,
' some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
r 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signature, I�Ertif hat this r Qszr_t.is_accurate and complete to the best of my knowledge:
re gePermittee or Designee)
Page 1 of 2
SWU-242, Last modifted 10/25/2012

I- Outfall Description:
Outfall No. 002 Structure (pipe, ditch, etc,) Concrete pipe
Receiving Stream:. Unnamed tributary to Roanoke River
Describe the industrial activities that occur within the outfall drainage area:
Roof drains
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:. t-4 kA
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
0 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
C) 2 3 4 5
b. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of stormwater Pollution:
List and describe Na 1 A
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, fast mod[fied 10/25/2012