NCG030552_Monitoring Report_20210818

Permit and Facility Information:
Neale enter the pem t rwrt6er and other detals for this udcuu.
IMPORTANT: Until the eDMR system is implemented for DEMLR Stormwater Program permits, an original signed
hardcopy of the DMR MUST be mailed to the address in your permit, in addition to this electronic upload.
Fields marked with a red asterisk are required.
Permit Number*
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NCG030552
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Facility Name:*
Schneider Electric
County:*
Rowan
After uploading here, the original signed hardcopy must be mailed to:
DEQ Mooresville Regional Office
Attn: DEMLR Stormwater Program
610 East Center Avenue
Suite 301
Mooresville, NC 28115
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Further contact details at https:l/deq.nc.gov/contact/regional-offices/niooresville
Monitoring Period Information:
Monitoring Period What is Ute YEAR of the sarmle dates sl7
Year:* 2021
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different years
with a new submittal form.
Also, copies of the lab results and qualitative (visual) monitoring should NOT be submitted unless specifically
requested by DEQ staff. Only upload the completed and signed DMR forms.
DMR Upload * aick llv upload button a drag and drop files here to attach docunent.
Spring 2021 Schneider Electric 2021 SDO
127.54K6
NCG030552.pdf
Only FOR are accepted.
Comments: First time using this upload system, Let me know if I have missed anything
* R By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
I agree that submission of this Data Monitoring Report (DMR) upload form is a "transaction" subject to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
I agree to conduct this transaction by electronic means pursuant to Chapter 66. Article 40 of the NC General Statutes
(the 'Uniform Electronic Transactions Act");
I understand that an electronic signature on this upload form has the same legal effect and can be enforced in the

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STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCSNCG030552 SAMPLES COLLECTED DURING CALENDAR YEAR: 2021
(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 Schneider Electric COUNTY Rowan
PERSON COLLECTING SAMPLE(S) John Pitel PHONE NO. 7( 04 )202-9417
CERTIFIED LABORATORY(S) Blue Ridqe Labs Lab # b2L-ZoZ1-0280
Lab sample ID Lab #_LS 1 1 - 2021- 0112(o
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Dyes (.)no
(if yes, complete Part B)
Part R: Vehicle Maintenance Activitv Monitorine Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
004
Total Flow
(if applicable)
Total
Rainfall
Oil &Grease
(if appl.)
Non -polar
O&G/TPH
1664 SGT-HEM), if
a 1.
LSoli?ds
pH
New Motor
Oil Usage
mo/dd/ r
MG
inc
m
unit
gallmo
Form SWU-247, last revised 611212015
Page I of 2

STORM EVENT CHARACTERISTICS:
Date 5/3/2021
Total Event Precipitation (inches):.5" {
Event Duration (hours): 3 hrs (only if applicable — see permit.)
(if more than one storm event was sampled)
Date I
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of law, that this doc*ent and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified persZnnel 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 a possibility of fines and imprisofiment for knowing violations."
7/8/2021
(Signat of Permittee) (Date)
ti
II
Form SWU-247, last revised 611212015
Page 2 of 2