NCS000385 DMR SW (4)

Y'
,i,
- STORMWATER DISCHARGE OUTFALL(SDO)
' MONITORING REPORT
Permit 1.,
Number S 0 . SAMPLES COLLECTED DURING CA1'EN! EAR: 2016
N � .,
(This monitoring report shall be received b t ue Di?i4I n no later than 30 days from
the date the facility receives the sampling resulf5•ri i tl� boratory.)
�4',y
FACILITY NAME: DSM Functional Materials RECEIVE* V
1101 Highway 27 South fu �`
Stanley,NC 28164 AUG 0 9 2016
CENTRAL FILES COUNTY: Gaston .%'
PERSON COLLECTING SAMPLE(S)Laura Pirtle DWR SECTION PHONE NO. [phone],
V
r "
1 , '.-'�.
CERTIFIED LABORATORY(S)N/A Lab#NA- __� i ' y
. ,; - ,-42,
-SIGNAT U RF'� PERMITTEE OR DESIGNEE)
By this snOE,I certify that this report is accurate
l
complete if,t re
a best of my knowledge.
Part A: Specific Monitoring Requirements (reporting frequency is semi-annual)
Outfall Date
No. Sample Total pH Total
Collected Suspended Rainfall
Solids
Unit Measure mo/dd/yr mg/L Standard unit Inches
Benchmark Values 100 mg/L 6-9 Rain Gauge
Re•ort Value
A
Outfall No. 1 none —A 0 c'lb(A) Insignificant rainfall during business hours;no sample could be obtained for period
Outfall No.2 none ® r‘A 0 Fib,, Insignificant rainfall during business hours;no sample could be obtained for period
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No. Sample Total Flow Total Oil& Total pH New Motor
Collected (if applicable) Rainfall Grease Suspended Oil Usage
Solids
mo/dd/yr MG inches mg/l mg/l unit gal/mo
NOT
APPLICABLE
Form SWU-247-112608
Page 1 of 2

k..
DSM Functional Materials
Permit Number: NCS000385
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date: NA Insignificant rainfall during business hours;
no sample could be obtained for period Attn: Central Files
Total Event Precipitation (inches): 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 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."
/// �
DSM Functiona • ials (Date)
Nakia Isler, Site Manager
Form SWU-247-112608
Page 2 of 2