NCS000236 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000236 SAMPLES COLLECTED DURING CALENDAR YEAR: 010 5
JUN 2 2 2015 (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 Industrial & Agricultural Chemicals, InCEN7RAL FILES
4itnrp eeGrInN COUNTY Robeson
PERSON COLLECTING SAMPLE(S) Ranrtall Anrjrpwc PHONE NO. ( 910 )843-2121
CERTIFIED LABORATORY(S) TPS 1-- Lab #�"1�l
ej 1 Lab # 1 �q
Part A: Specific Monitoring Requirements
Outfall'' Date
Sample..
Collected.
mo/c
37804 U -1
50050
50050
Total, .
Flow (if app.)
Total',
Rainfall
MG
inches
00400
O • 55
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes k no
(if yes, complete Part B)
Part R- Vehicle MaintPnnnrP Arfivifv Mnnit—:....
Outfall Date
No. Sample
Collected
50050
SIGNATURE OF PERMITTEE OR DESIGNEE
00530
00400
REQUIRED ON PAGE 2.
Total
Rainfall
Oil & Grease
(if appl.)
00400
01022
01042
01051 01092 00530 _
00,556• Biochemical �JChemic
pH
Oil & _
Total
Total Boron Total Total. Lead
Total -Zinc Oxygen
'Oxygei
al/mo
Grease
SuspendedCopper
Demand _
'. Deoian�
Solids SS
-
(BOD) -
(COD),
Units
m /l
m /l
m m /l mg/1
m /l m
m
N
.0 C).Qd� C).noc:�
V L'1 rl
C -2r, ,
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes k no
(if yes, complete Part B)
Part R- Vehicle MaintPnnnrP Arfivifv Mnnit—:....
Outfall Date
No. Sample
Collected
50050
00556
00530
00400
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/ r
MG
inches
mg/1
m
unit
al/mo
Form SWU-247, last revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date q-1 6 T5 O
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation ' ches):
Event Duration (hou (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 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."
(Signature of Permittee)
A -15 -IS
(Date)
Form SWU-247, last revised 2/2/2012
Page 2 of 2