NCS000048 DMR SW (3)

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
Permit Number T@ -00004 or SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
Certificate of Coverage Number:NCG (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 Chemol COUNTY Guilford
PERSON COLLECTING SAMPLE(S) Chasity Hart PHO O( 336 )33�3-)55
CERTIFIED LABORATORY(S) R&A Laboratory Lab# 34 / 4.,2b--b->.J
Lab# (SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature,I certify that this report is accurate
complete to the best of my knowledge.
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total Oil&Grease pH TSS COD BOD-5 Total Total Nitrogen
Collected Flow Phosphorous
mo/dd/yr MG mg/I Std units mg/I mg/1 mg/1 mg/1 mg/1
1 05/05/2016 43.09 <5 5.12 26.3 71 17.5 0.224 <1
p E E Lc Nitrate+Nitrite
mg/I
JUN 06 ZU16 0.351
CEN IRA_FILES
DWR SECTION
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 50050 00556 00530 00400
No. Sample Total Oil&Grease Total pH New Motor
Collected Flow Suspended Oil Usage
Solids
mo/dd/yr MG mg/1 mg/I
Form SWU-246-051100
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STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date 5/5/16 Attn: Central Files
Total Event Precipitation(inches): L4.4_ 1617 Mail Service Center
Event Duration(hours): 4 Raleigh,North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation(inches):
Event Duration(hours):
"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) (Date)
Form SWU-246-051100
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