NCS000045 DMR SW (2)

Permit Number: NCS 000045 or
Certificate of Coverage Number: NCG
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 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 AIRGAS COUNTY MECKLENBURG
PERSON COLLECTING SAMPLE(S) RANDALL MILLER P NE O 704 644:4249
CERTIFIED LABORATORY(S) PACE ANALYTICAL SERVICES Lab # 40
Lab #
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
Total
Flow (if app.)
Total
Rainfall
Total
Suspended
Solids (TSS)
pH
00400
mo/dd/ r
MG
inches
m /L
S.U.
001
10/28/15
N/A
0.61
8.5
6.7
002
10/28/15
N/A
0.61
12.6
6.8
003
10/28/15
N/A
0.61
11.4
6.8
004
10/28/15
N/A
0.61
6.2
6.7
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes x no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
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
m /I
m /l
Units
al/mo
Form SWU-246, last revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date 10/28/2015 Attn: Central Files
Total Event Precipitation (inches): 0.61 1617 Mail Service Center
Event Duration (hours): (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.)
"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 kn?,vqedge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false information,
including t ssibility of fines and imprisonment for knowing violations."
of Permittee)
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(Dat
Form SWU-246, last revised 2/2/2012
Page 2 of 2