NCS000325 DMR SW (16)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325 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.)
FACILITYNAME Patch Rubber, Company COUNTY Halifax
PERSON COLLECTING SAMPLE(S) _ Not applicable PHONE NO.2( 52) 536-2574
CERTIFIED LABORATORY(S) Lab # _
Lab it
SIGNATURE OF PERMITTEE OR DESIGNEE
Part A: Specific Monitoring Requirements REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part R: Vehicle Maintenance. Aeflvity Mnnitnrinn Rnn..:rmm�n l�
Outfall Date
No. Sample
Collected
Sample11
Collected
1 Y.
U1.' . 1 1 1 1 1 •
00556
00530
00400
Total Flow
(if applicable)
jingle
,
Non -polar
O&GiTPH
(Method 1664
SGT -HEM), if
appl.
Total
'Suspended
Solids
pH
New Motor
Oil Usage
mold yr
MG
inches
MPA
m FA
unit
J1211MO
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes Xno
(if yes, complete Part B)
Part R: Vehicle Maintenance. Aeflvity Mnnitnrinn Rnn..:rmm�n l�
Outfall Date
No. Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl)
Non -polar
O&GiTPH
(Method 1664
SGT -HEM), if
appl.
Total
'Suspended
Solids
pH
New Motor
Oil Usage
mold yr
MG
inches
MPA
m FA
unit
J1211MO
Form SWU-247, last revised 1/2/1012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
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 Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, underpenalty (lav, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to asst[ that qualified personnel properly gather and evaluate the information submitted. Based on my Inquiry of the person
or persons who mann the system, or those persons directly responsible for gathering the Information, the Information submitted is, to the
best of my knon•led � and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the pos5i lih� of fines and imprisonment for knowing violations."
Permittee)
(Date)
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of February 2016. "No Flow"
Form SWU-247, last revised 2/212012
Page 2 of 2

ENGINEERING & ENVIRONMENTAL
Certified Mail No.: 7015 0640 0003-0331 4043
Return Receipt Requested. ;s
March 14, 2016 ,
Division of Watei= Quality
Attention: C%entfal Files
1617 Maij,,Se
. rvice Center
Raleigh,North Carolina 27699-1617
MAR I 1 2016
CFENTL OWR SECTIO S
Storm Water Discharge Outfall (SDO) Monitoring Report - February 2016
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27870
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for February 2016.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of February 2016.
• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
r'
Amy L. Trimble, CHMM
Environmental Scientist
ALT: mll
Enclosure
.+ cc:--Mar_lo Carter, Patch -Rubber Company-----
0APatch Rubber Company\16-105\Final\ALT 16-105 - Storm Water SDO February 2016 Cover Letter. docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p.815.235.7643 I f 815.235.4632 1 www.fehr-graham.com
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