NCS000336 DMR SW (4)

CI
IN 110.
Universal Forest Products, Inc.
May 11, 2016
North Carolina Division of Water Quality RECEIVED
Surface Water Protection Section
ATTENTION: Central Files MAY 16 2016
1617 Mail Service Center
CENTRAL FILES
Raleigh,North Carolina 27699-1617 DWR SECTION
RE: Discharge Monitoring Report, Sample Period No. 14
UFP Elizabeth City, LLC
NPDES Permit: NWSii 9 43 I`
Dear Sir or Madam:
Enclosed, please find the storm water report for Sample Period No. 14 (November 1,
2015 through April 30, 2016) at the above-referenced facility..
Please do not hesitate to contact me at [phone] or [e-mail] if you have
any questions or require additional information on this matter.
Thank you,
Of
Joseph Mark, CPG, RG
Regulatory Compliance Administrator
Enclosure
Corporate Headquarters
2801 East Beltline NE Grand Rapids,MI 49525 Tel:[phone] Fax:[phone] www.ufpi.com

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
Permit Number NCS 000336 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.)
FACILITY NAME UFP Elizabeth City, LLC COUNNT NO.(252 )t 338- 2821
k
PERSON COLLECTING SAMPLE(S) Adani Ritz
CERTIFIED LABORATORY(S) Priep&Newhof Lab#
Lab#
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A:Specific Monitoring Requirements
Outfall Date 50050 l Total
No. Sample Total Total BODS COD pH TotzaTSS
Collected Flow(if app.) , Rainfall Nitrogen Copper
mo/dd/yr MG inches mg/L m /L
g(L S.U. mg/L mg/L mg
001 04/22/2016 Sample was collected;however,it was not shipped to the laboratory.Holding times were_exceeded.Una`)le to collect
002 another storm water sample prior to the-end_of the monitoring period_
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?,yes gno
(if yes,complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No. Sample Total Flow Total Oil&Grease Non-polar Total pH New Motor
Collected (if applicable) Rainfall (if appl.) O&GITPH Suspended Oil Usage
(Method 1664 Solids
SGT-HEM),if
appl.
mo/dd/yr MG , inches mg/1 mg/I unit gal/mo
Form SWU-247,last revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date Apri122,2016 Attn:Central Files
Total Event Precipitation(inches): 0.12 1617 Mail Service Center
Event Duration(hours): 1 (only if applicable—see permit.) Raleigh,North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation(inches):
Event Duration(hours): (only if applicable—see permit.)
This DMR is for the period from November 1,2015 through April 30,2016.
"1 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."
x.".---7)es-
-- e...da___
„---/„/.,„
(Signature o ermittee) (Dat
Form SWU-247,last revised 2/2/2012
Page 2 of 2