NCS000328_2022 DMR_20221028 (5)

Form SWU-247, last revised 6/12/2015
Page 1 of 2
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS________________________ SAMPLES COLLECTED DURING CALENDAR YEAR: ________
(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 __________________________________________________ COUNTY
PERSON COLLECTING SAMPLE(S) _________________________________PHONE NO. (_____)
CERTIFIED LABORATORY(S) _________________________Lab #________
_________________________Lab #________
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
Outfall Date 50050
No.Sample
Collected
Total
Flow (if app.)
Total
Rainfall
mo/dd/yr MG inches
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? yes no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No.Sample
Collected
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non-polar
O&G/TPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH New Motor
Oil Usage
mo/dd/yr MG inches mg/l mg/l unit gal/mo
NCS000328 2022
BESTWAY SOUTH, INC.
Ryan R. Osborne (INENCO, INC.)
440
IREDELL
704 585-6373
Statesville Analytical
INENCO, INC. 5540
pH Ar Cr Cu BOD COD
1 06/14/22 NA 0.20 7.01 0.029 0.017 0.010 7.68 29
N O&G TSS
1 06/14/22 NA 0.20 2.00 < 5 12.25
1 <20
Note: Permit Benchmarks and all results are listed in mg/L except for pH which is Standard Units.
STORM EVENT CHARACTERISTICS:
Date 6/14/22
Total Event Precipitation (inches): 0.20
Event Duration (hours): (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 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 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."
/o L7, it ZZ
(Signature of Permittee) (Date)
Form SWU-247, last revised 611212015
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