NCS000592_MONITORING INFO_20191217

IZz/o
STORMWATER DIVISION CODING SHEET
NCS PERMITS
I
PERMIT NO.
�" OD
'V
DOC TYPE
❑ FINAL PERMIT
MONITORING REPORTS
❑ APPLICATION !
❑ COMPLIANCE
❑ OTHER
0 r 7 I
DOC DATE
❑
YYYYMMDD I
1

i
�I
!? ,
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on, f lling out this form, please visit ljitps://cloy.tic.goy/about/divisions/ongray-mineralLland-
resources/ cr gy -nii ii eraI -la d- c n'tslst rn k r- ert ,-i ndusLrialm,,w jab-
Permit No.: NIC/ SI (a b1 D/5 /9lgl or Certificate of Coverage No.: N/C/Gl_ /—/ I 1 I_I
i
Facility Name: C u lh"P-r Oj Zaa pb V ,� . k
County: �b-tcz�} a _ - - -- — Phone No. A5a. - J(j- T
Inspector: �4l'>y Ala►v.
�- CAb`jo T
Date of inspection: G
I rg r—
Time of Inspection: '• s
i OF
Total Event Precipitation (inches): .54 _ - ICL i%, I RAL FILES
P R SECTI0N
All permits require qualitative monitoring to be performed during a "measurable storm event."
Y
A "measurable storm event" is,a storm event that results in an actual discharge from the permitted
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour
site
storm
interval does not apply if the permittee is able to document that a shorter interval is representative
local storm events during; the sampling period, and the permittee obtains approval from the local
Regional Office.
for
DEMLR
By this signature, I certify that this report is accurate and complete to the bestlof
my knowledge.
(Signature of Perm ittce or Designee)
I�
I
lE
1. Outfo. al Description: (�
Outfall NStructure (pipe, ditch, etc.): tAe j�koo �ywD
Receivin tream: n { { _ �{�
C eot t Q 1� ID C, ECG
Describe the industri I activities that occur within the outfall drains a area:
Ci U tau
I
I�
I
Page l of 2
SWU-242, Last modified 07/2812017

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
riptors: —Ojew
3. Odor: Describe
chlorine odor, etc.): _
i
iy distinct odors that the discharge may have (i.e., smells strongly of oil; weak
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
i fl 3 4 5
5. 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:
I V 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 3 4 5 ,
7. Is there any foam in the stormwater discharge? o Yes e No.
8. is there an oil sheen in the stormwater discharge'? OYes W No.
9. Is there evidence of erosion or deposition at the outfall? O Yes ®No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe I Nye
Note: Low clarity, high
indicative of pollutant e
and/or the presence of foam, oil sheen, or erosion/deposition may he
:. These conditions warrant further investigation.
5WU-242, Last modiGrd 07/28/2017
Page 2 of 2

i
KIr"a
Envimnmenmt
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq,iic,gov/ubouVdivisions/energy_lnineral! lalid-
resources/eneray-mir>-craI-land-numits/s arrtttivUgr-pen ' s/ -industrial- w# h-4
Permit No.: NIC1-1 �1 �.) C�1 -4 or Certificate of Coverage No.: NIC/GI_I_ _l_I_I_I I_I
FacilityName: ruth. Q-P� 6&taor(. 19.4SNT I
County: ctk Phone No.5�—'�
Inspector:
Date of Inspection:
Time of Inspection: r.
Total Event Precipitation (inches): .5
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
o
Regional Office. I
By this signature, I certify that this report is accurate and complete to the best Iof my knowledge:
(Signature of Permittee or Designee)
I. Outfall Description:
Outfall No. cz Structure (pipe, ditch, etc.):
Receiving Stream:
Describe the industrial activities that occur withirLthe outfall drainage area:
Page 1 of 2
b
SWU-242, fast modified 07/2812017

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: lea r
I '
3. Odor: Describe an
chlorine odor, etc.):
odors that the discharge may have (i.e., smells. strongly of oil, weak
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
2 3 4 ,� 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 S -
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 S
7. Is there any foam in the stormwater discharge? O Yes ® No.
8. is there an oil sheesi in the stormwater discharge? OYes
9. Is there evidence oflerosion or deposition at the outfall?
10. Other Obvious
List and describe
of Stormwater Pollution:
4D No.
O Yes 0 No.
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/depositio.n may he
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
S WU-242, Lust modified 07/28/2017

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS-4�_ SAMPLES COLLECTED DURING CALENDAR YEAR: ann
(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.)
FACILITY .r F—D z o-� — COUNTY FTfi�E k -�
PERSON COLLECTING SAMPLE(S) _ PHONE NO. (;15.-).) 501 - (oUfTO
CERTIFIED LABORATORY(S) �v�rn�3r+,�.N (- 1. jW_ Lab #_ a1 I
Lab #
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
� � '�•';
- :
i - v - 1 ii
1 r'
- ��
f . � � h'
t, r�, , r
F S.S+� n. � y.. �
- �..
� ��i 3'r - �'
t •y,�-
�rve.
S }r, . '., �t
.,as .,z, �,
- �I'Y -;�tr� �:C-�'Y6. ,914t
_ "fix -.c*' ��
k� �S'$�
- �
��s� r�T��� . �r-
I !•f
_
p.�:./
1
St j-1` t+7x•e
�.
.
- iE';. 'z*
4. �`e'.,�,rW.•3.�(
•'�5�-- "c1.
".
' ' r.^`o .kl s
f�ifwtl'c-,
"!-1•7•:-,
'�..sn
Lr,>'
--.y'---_. i'Try,,
~' a .'
'"`
i:• : -�K.' P
- :x,, .'f_�-
1 i 'j1Sin...-H
'.�Z.,
,a;,�x�1
nM
ei;.� .r—__
`✓: -:. '••1 '�
'R^d''�.sfsrsL
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes j io
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
d•, Fs ? y-d
I r` � } �
�.� ih: �#'.i�
ice,
� � �
y� ��� '� `!s
ys�i5.`�.j'i ��s(
i ,y�F - ,'x _.y:
� '. it t y "��
r 1 �1 ��
`�� _ %-sYt`�
'T' r:-.�Y.'�'�� .1...�iT�'.
.Y .t�� ?�_ Ct"Y }
i i -_, hiiSrY' fi
}I.
R _ _.' •�
- t -
ry„LF L x
j 1 ��
f _ gn—l"
^i
MUM
1
} 1 1 1
Ty,
� �'r.. M,1�� �,.j'�mr�i�s3�
r+..Y'' -3 Y t�'�`♦fyc7^..
E� _, •��.
�f����s,r'
! k: }
! 11 4 ��-2��
TT���1
�4 '`� ' ,'�`�'l
G ��g-tJ _sc.ti
..alS�
� f - ;.
f ! ��'�
'�''
,1� '�tµ-.yk„w`.
F[ '.�.�, `'� j 5..
�Sii '.a. �� VS=ufi—F�
��
1 i �
4 � •til"�rt'Y
•
�
f � a 1 1
-'.b�Yr'�."�.7�i��h
��'
i i• C 7.. -
1 t-:-li! 1 ��:�
f;�i C -
f '�' r� ,1�:
'i/f'
Q" +t3
5 .y �'��.
� �1� +��Iv
..1� �-`4• `�"Ti`LS',b�MS /
- �'T. ''1. �
I 1
p � J
Y Y 1' �±y".
.vF 3y��A
� � � y,.
W13.-.�-�]v 5!'1
111 f !• ,-jf.l
i
i
st 9. t.33�.,f
1 ji, ^i�,c?ls�i"ra�
If �E'L�.jM:•
�.M, Y ���,^�%
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
- ---- -Date
Total
Total Event Precipitation (inches): ' Z'4'-
Event Duration (hours): 3 6; (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Niles
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 anoimprisonment for knowing violations."
of
i(PV�
(Dt-0
Form S WU-247, last revised 21212012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year ylp lq
Individual NPDES Permit No. NCS
Certificate of Coverage_(.COC)_No,—NCC
or
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Na e: fiber <?P' 1 Nta4r_ TreA Qs _
County: Wk.,
Ph-orie­NumtYer:(;�SA�:- )—Sf---Total-no. of-SDOs-monitored oZ
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No [$[,
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ Nox]
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency [l
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ Nox
}A �'� :�'Yf�56'i9'
MM
Wl11
T { .`
3 ._-YJ hr,�`';,=g
�f 1� JM M.L' _715V'•y
.r+.1t • �
-I4�rh S�[/_� .F1
Inz��
�7%G��4
�� � �� „�i?
Z
M:o.-•�� ,F�Mf��.•�i,.,
_
♦ • � D s
�Date4Sarnpfe
^Cull
rirtml X
.�I
kp
S
:t✓a�
3
�.�
SWU-264 - Generic Annual DMR
Last revised 5 1712013

Additional Outfall Attachment
Outfall No. a -
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall-ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last,year, why was monthly monitoring discontin— x d?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle,maintenance activities? s Yes ❑ Noz
<,
t.
.'� ' ; eS
:iss4��IPIiEii�le$'
��
,Ra�nfaf
::.i•,.�'3? �4�'S
� F, ,r' x i _� ' `Paiarrtete ; {units �
.. i ;t+? may.
�� ]A��•• � �_ �a. 1•+ .r.\ ,>�r � y`{'� ' �v _ `� .5�•'r` � ��
F D 'i: E4 *�, •s4 �.. ,. •i u+n�'��J(,,�. r E. _S" Sr•'�
as z ty i r �i� a r�_M_ s��� rE? *;'�• k,y,x,L ' r
h A, -r.�� =� !1�' .,�•.�-'a z�,..��' s. * !
'Benehmark
©ate=Sample
+F4e�JIf@fiy,W
> �.mrnldity]►
`•f N/A'r
�7
a�
�4 t7 g . O O
�70 - q
av
< . — 05
L . 0a5
. aD L
L ,
SWU-264 - Generic Annual DMR
Last revised 511712013

I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imp-ci5onment-for_knowing-violations."
Signature
Date III
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
2090 US Highway 70
Swannanoa, NC 28778
[phone]
3800 Barrett Drive
Raleigh; NC 27609
[phone]
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
943 Washington Square Mall
Washington; NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
'To wmim Prow i
end p�i�noe :. i
Nadh C&ot »w's wrater :.' j
SWU-264 - Generic Annual DMR
Last revised 5/17/2013

r. F �.. J
`
_ � �•Y

z '4K' u5 �R '' SI k�,I
'YS. - Y.S.C•�'jj _.
.a.-
« iy }
Drink_1ng Water IDS. �7715
.
1-.II�iV6 tS WSt9 i 1Di 1�
k'T"�.i
ys�it
114 OAKMONT DRIVE
PHONE [phone]
GREENVILLE. N.C. 27858
IFAX [phone]
CULPEPPER WOOD PRESERVERS
ATTN: BILLY RODGERS
2262 W. 10TH ST.
ROANOKE RAPIDS ,NC 27870
ID#: 271
DATE COLLECTED: 1OV16/19
DATE REPORTED : 111/18/19
REVIEWED BY:
Stormwater
Storunwater
Analysis
Method
PARAMETERS
(#I, Grab)
(#2, Grab)
Date Analyst
Code
BOD, mg/1
16
<2.0
10/17/19
TMR
52i0B-II
COD, mg/1
53
<20
10/18/19
SEJ
H8000-79
Total Suspended Residue, mg/1
6.2
<2.8
10/18/19
HJO
254019-I1
Arsenic, mg/1
0.038
<0.005
10/29/19
NITtiI
3113E-10
Total Chromium, mg/l
0.022
<0.005
10/25/19
LFJ
EPA200.7
Copper, mg/1
0.434
0.002
10/25/19
LFJ
EPA200.7

Environment 1, Inc.
P.O. Box 7085. 114 Oakmont Dr.
Greenville, NC 27858
environment linc.com
Phone [phone] : Fax [phone]
CLIENT: 271 Week- 42
CULPEPPER WOOD PRESER ERS
A'I"rN-. BILLY RODGERS
2zsz
CHAIN OF CUSTODY RECORD
DISINFECTION
Ij CHLORINE
UV
❑
rl NON P P P P P
W. IV it ST.
ROANOKE RAPIDS NC 27870 A I C I A A A
[phone]
SAMPLE LOCATION
Storniwater (#I, Grab)
Stormwater 02, Grab)
�z
�o
E
Fr O
O
¢O
LU
z
c]
¢
w
COLLECTION
o
8
`�`� ¢
p
c
v0
x
`
v
z
—
DATE
TIME
��
4
BY [ G.) (SAMPLER) . UAI E! I iME
:30
BY (SIG.) DAT'EITIME
BY (SIG.) i DATEITIME
BY
BY
RECEIVED BY (SIG.)
UAI G I IMr- COMMENTS:
04-7a7 1 q!SL
DATEiTIME
Page I of l
CHLORINE NEUTRALIZED AT COLLECTION
pH CHECK (LAB)
CONTAINER TYPE, PIG
CHEMICAL PRESERVATION
F A -NONE D-NAOH
LU
cn
B-HNO3 E-HCL
w C- HZSO, F -ZINC ACETATE/NAOH
G - NATHIOSULFATE
CLASSIFICATION:
WASTEWATER (NPDES)
DRINKING WATER
DWRIGW
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) MAINTAINED
DURING S MENT/DELIVERY
N
SAMPLES COLLECTED BY:
(Please Print)
�XA PQCN ti1� _
SAMPLES RECEIVED IN LAB AT _� Z 'C
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C for composite sample or a "G" for
FORM a5 Grab sample in the blocks above for each parameter requested. N 0 3 7 0 3 5 5 '

SAMPLING INSTRUCTIONS AND FORM COMPLETION
FAILURE TO PROPERLY CHILL, CHEMICALLY PRESERVE, COLLECT IN PROPER BOTTLE
TYPES, MEET REQUIRED HOLDING TIMES, NEUTRALIZE CHLORINE IN CHLORINE
SENSITIVE SAMPLES, AND SEAL COOLERS WITH TAPE WILL RESULT IN SAMPLES BEING
REJECTED BY THIS LABORATORY AS PER NORTH CAROLINA REGULATORY CODE.
l) Samples not falling within the required guidelines will need to be re -collected. The client will be contacted and informed of any
deviation and asked to collect another set of samples. The client may request the laboratory to proceed with the analyses of the current
samples. Any samples analyzed outside of the required guidelines will be "qualified". This means that a note will be included on the
sample result and "Chain of Custody' specifying the deviation. The laboratory is also required to send a letter to the'State noting the
deviations.
2) Sample Temperature. Samples for compliance monitoring must be chilled with wet ice to a temperature of 6C or, less. Freezing is
not permitted. Samples delivered to the lab shortly after collection may not have had enough time to be chilled below 6C. 1n this case the
temperature at time of collection must be noted in the space provided. The samples will meet the requirements of the regulation if there
is a temperature drop from the time of collection until received in the lab. Regardless, all samples should be packed in wet ice using as
much ice as will fit in the cooler.
3) Sample Chemical Preservation. Many samples require a chemical preservation such as Sulfuric Acid or Sodium Hydroxide. The
laboratory will either provide the preservative in the sample bottle, or in the case of 40 till. Volatiles Vials, provide a bottle of Acid with
detailed descriptions on how to collect the sample. Never rinse sample bottles before collecting samples. Any residue or liquid in the
bottle is required for proper chemical preservation. The lab must verify proper chemical preservation upon arrival in the lab and will note
this information in the spaces provided on the front of this form.
4) Chlorine Neutralization. Some samples require that any Total Chlorine Residual be removed at the time of collection. The lab will
provide the proper neutralizing agent in the sample bottle when technically possible. There are some samples (Total Kjeldahl Nitrogen
and Ammonia Nitrogen) where this is not possible due to interferences between the required chemical preservation (Acid) and the
dechlorinating agent. Therefore, these samples must be de -chlorinated at the time of collection before being placed in our sample bottles.
Sodium Thiosuff'ate is the chemical of choice to neutralize chlorine. It must be added to your sample and then the sample checked for
Total Chlorine before the sample is poured in our bottle. Facilities using chlorine for disinfection should have a means of measuring Total
Chlorine. Non -chlorinated sample sources will not need to be checked. The person neutralizing the chlorine must put his initials in the
"Chlorine Neutralized at Collection" row on the front of this form above the proper parameter. Samples such as Coliforms (which have
Thiosulfate in the bottles shipped from the lab) will be checked for proper neutralization upon arrival in the lab. It is also required that you
note the "Total Chlorine at Collection" on the front of this form for any sample locations applicable. This value would be betore any
neutralization is performed.
5) A "C" for Composite Sample or a "G" for Grab Sample should be placed in the box for all requested parameters. Grab temperatures
as well as Composite start dates and times can be recorded in the "comments" section.
6) Other information required to be completed by the client are:
Collection Date and Collection Time for each sample location Temperature at Time of Collection
Printed name of person or persons collecting samples Signature, Date, and Time samples are relinquished
Other added sample locations and analyses required Type Of Disinfection
Deletion on the form for any samples which are not needed (example: dry upstream location)
Any other information felt to be pertinent should be included in the "Comments" section
CONSIDERATIONS:
Coliform and Enterococci samples have a holding time of hours from time bfcollection to time of analysis. Therefore, samples should
be collected as late in the day as possible to allow enough time for transportation, checking in at the lab and analysis.
BOD, Nitrate, Ortho Phosphorus, Settleable Matter, Turbidity, Color, and MBAS samples have a 48 hour holding time. The lab reserves the
right to establish required sample collection and delivery dates in order to meet the required holding times.
CAUTION
Sample bottles may contain acids or other corrosive and potentially harmful chemicals. Laboratories are required to add these chemicals
for certain analyses in order to comply with EPA preservation requirements. Use extreme care when opening and handling the shipping
container and bottles. If any chemical should get into your eyes, on your skin or on your clothes, flush liberally with water and seek medical
attention. Material Safety Data Sheets (MSDS) are available upon request which specify proper handling and personal protection.