NCS000508 DMR SW (14)

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North Carolina Department of Environment and Natural Resources
To: Division of Water Resources Division of Water Resources
Attn: Central Files Winston-Salem Regional Office
- 1617 Mail Service Center 585 Waughtown St.
Raleigh,NC 27699-1617 Winston-Salem,NC 27107
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Discharge M. > itoring R;port
Facility Name: Piedmont Triad International Airport Permit: NCS000508
County: Guilford Phone: [phone]
Person Collecting Sample: Toby 5. Benfield, ECS Carolinas, LLP
Certified Laboratory(s): Research &Analytical Laboratories,Inc. Lab #: NC#34
Lab #:
Date of Sample Collection: May 16.2014
Schedule: Year 4 (Permit 2)
Period 4 _ (quarter)
Episode (deicing event)
Tier Two 6 (month)
ADF Applied (if applicable) 0 gallons on May 14,2014
0 gallons on May 15,2014
0 gallons on May 16,2014
Total Event Precipitation: 0 inches on May 13,2014
0 inches on May 14,2014
1.6 inches on May 15,2014
Qualitative and/or Quantitative 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.,ancl be.l ef;true,accurate, and complete. ; am
aware that there are significant penalties for submit/66g f.159F.Information, including the possibility oe
fines and imprisonment foylcnowinlg,riioiations.-'f ,7 / \ 7/
Signature: ' J �',_�r' Date: -._ - JJ / /
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