NCS000508 DMR SW (11)

FEB 122015
CEf L �-
To: North Carolina Department of Environment and Natural Resources 3WR s �ILES
Division of Energy Mineral and Land Resources ECTIoN
(original Attn: Central Files
&1 copy) 1617 Mail Service Center
Raleigh, NC 27699-1617
Discharge Monitoring Report
Facility Name: Piedmont Triad International Airport Permit: AFTSCRIAME916.
County: Guilford Phone: [phone]
Person Collecting Sample: B.J. Lineback, Pilot Environmental, Inc. [phone]
Certified Laboratory(s): Research &Analytical Laboratories, Inc. Lab #: NC#34
Lab #:
Date of Sample Collection: January 23,2015
Schedule (NPDES 2): Season 5 (year)
Period - (quarter)
Event 4 (deicing)
Tier Two - (month)
ADF Applied (if applicable): 50 gallons on January 23, 2015
265 gallons on January 22,2015
0 gallons on January 21,2015
Total Event Precipitation: 0.71 inches on January 23,2015
0.00 inches on January 22,2015
0.00 inches on January 21,2015
Routine, Deicing Event,and/or Tier Two Analytical Monitoring Results Attached
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: Date: 2-9-15
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