NCS000325_COMPLETE FILE - HISTORICAL_20191210

t FEHRGRAi.'�M
ENGINEERING & ENVIRONMENTAL
UPS Tracking No. #1 Z6513950355408372 RECEIVED
December 4, 2019 DEC 10 201.9
Division of Water Quality
Attention: Central Files L rye
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Storm Water Discharge Outfall (SDO) Monitoring Report - November 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 November 2019.
G Please note the following:
C Storm water samples were collected during a representative storm event on
November 12, 2019.
• 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,
TA- fm
Amy L. Trimble, CHMM
Environmental Scientist
ALT: dep
Enclosures
cc: Mr. Marto Carter, Patch Rubber Company (with Enclosures)
0:1Patch Rubber Company119-1051PA Finat119-105 Patch Rubber Co. - 2019.12.04 - November 2019 Storm Water SDO
Report.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www,fehr-graham.com
Insight. Experience. Results.

STORMWATER DISCIIARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000
FACILITYNAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Ma r l n (-'a rt-Pr _
CERTIFIED LABORA'I'ORY(S) Mpri t-Pc,.h T,ah 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
PHONE NO. 2{ 52 }536-2574
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
O
No.
Sample
ample
ct
II I
Tot
11
1
1
1
11
1
1
11
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)
-art is: venicie maintenance
Outfall Date
No. Sample
'Collected
r
50050
00556
U053W.
0040�
r .,.
Total Flow
Total
Oil & Grease
Non-polar,
7 otaC
pII'
`New Mgtor
(if applicable)
Rainfall
(if kppl.)
O&G/PPH
Susp"e"'nded ;
Oil...Usage
{Method 1664
fl
Solds.
SG I' HEM), if=
app1. -
MG
1 inches .1
ma/l I
knil!/I.
unit
.aat/mo'
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CII AILLCI'ERISTICS:
Date 11/12/2019
Total Event Precipitation (inches): 0.13
Event Dii ra (ion (hours): (only ifapp]icable —see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (fours): (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 prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly bather 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 like possibility of tines and imprisonment for knowing violations."
ller-yia 12/03/2019
(Signature of Permittee) (Date)
Form SWU-247, last revised 21212012
Pnee 2 of 2

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Amy Trimble Report Date: 11/25/2019
Client: Fehr Graham NPDES #: NCS000325
221. E Main St Project: Patch Rubber Co.
Freeport, IL 61032 Date Sample Rcvd: 11/13/2019
Meritech Work Order # 11131.955 Sample: OF 001 N Grab 11/12/19
Parameters Results Analysis Date Reporting Limit Ale-thod
COD
Zinc, total
<15 mg/L 11./1.5/19 15 mg/L EPA 410.4
0.393 mg/L 11/1.9/19 0.010 mg/L EPA 200.7
Meritech Work Order # 11131956 Sample: OF 002 S Grab
Parameters Results Analysis Date kepQrting Limit
COD 18 mg/L 11/15/19 15 mg/L
Zinc, total 0.039 mg/L 11/19/19 0.01.0 mg/L
11/12/19
Method
EPA 410.4
EPA 200.7
I hereby certify that 1 have reviewed and approve these data. Apm n-i a �n u 'M h )
Laba Cory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

5-4-]Ol6
Chain of Custody Record (COC)
NPDES#:AL J =325
Client: '
CliF'��1( (2yo —rrn . Phone: £�15 35- 0
Address: 00t E. rndAn f t'• Fax: �8&) a35 •-�'E3 uA
�Cxtrrrr►bl✓��chr�nxrYm.tan`1
"Yr' �rX `il - [,plQ , Email: fnZrfer-patrl-ir' bbc'r. earn
p�JSZ1f-J'• ICF-�> Project:a-V AUbt` jr(!Qinrnn�l
P.O.#:
Turn Around Time*
Attention; Am'-Fy1Mt*j
How would you like your report sent? *RUSH Work needs prior approval.
�"� 5td 10da s) 3 5 Da s 24-49Hrs
Circle all that apply_ Email referred), Fax, Mail I � I ❑
M E R I TE CFI INC.
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
1i'vVt/w.r-neri�techlabs.corn
_ - -- -�- - -- _ _-
Sample Location and/or ID #
Sampling Dates & Times
Person Taking Sample (Sign/Print):
Lab Use Only
Start
End
Comp?On
crab?
Co t.
Test(s) Required
Ice?
Yes / No
p H OK?
Cl OK?
Date
Time
Date
Time
)r on Ii1,IZt1�
l:p1PM
1t11Ztl`l
:�
lT
i
�?
Temperature Upon
Receipt: } ''N
Method of
Shipment:
*** Dechlorination (<0.5 m} of Ammonia, Cyanide,
Phenol and TKN sam les must be done in the field rior to reservation. ***
Comments:
Compositor #
❑ UPS
Jug #
❑ Fed Ex
Are these results for regulatory purposes? Yes
IX No ❑
Report results In: mg/L mg/kg ❑ ug/L ❑
❑ Hand Delivery
Relinquished by: Date:
a I r3l
Time:
11'• d3
Received by: /1 J�� D te7,_ C Time: C j
C i •- J � _
Other
Relinqui'Aby, /Dt=
Timer J
Received by: Date: Time:
Relin is d by: Date:
Time:
Received•b labs i 1„ j Date: Time:

f
.aM .
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit a
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Coz1„eanv
County: Halifax Phone No. 252-536-2574
inspector: AahY�h6 -\jCV-L-A
Date of Inspection: \\ �yLu q
Time of Inspection: _ V.1_LT_
Total Event Precipitation (inches): O. %'S" r7 H 5
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
X Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
l Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall, The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signature, [ cei-5 y thaUhis report is accurate and complete to the hest of my knowledge:
(SAnature of Pe (mittee or Designee)
Pagel of 2
5WU-242, Lastmadified 10/25/2012

1. 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: r A 1 T
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
[l� 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:
(1) 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes Nt]
4. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe h10 ;R
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Lastmodlfied 10/25/2012

NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out thisform, please visit: htto://portal.ncdenr.orgfweb/�vgfws/sti/npdessw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: Patch Rubber Company
County: Halifax Phone No. 252-536-2574
Inspector: —Mario
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): O. iZ" J� '
1
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
EK Yes ❑ No
Please -verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
re of Permit de or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

- - 1.-...---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:
North 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: - - C
3. Odor: Describe any dis 'nct 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:
(9 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
1.0. Other Obvious Indicators of Stormwater Pollution:
List and describe /'1__ _
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
5WU-242, Last=dified 10/25/2012