NCG180194_DMR_20191031

STORM WATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
GENERAL PERMIT NO.: NCG180000 SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
CERTIFICATE OF COVERAGE NO. NCG180194 (This monitoring report is due at the Division no later than 30 days
FACILITY NAME : Klaussner Furniture Industries from the date the facility receives the sampling results from the
PERSON COLLECTING SAMPLES: Susan Feir laboratory.)
CERTIFIED LABORATORY: Meritech,Lab# 165 COUNTY Randolph Z
PHONE NO.( 336)625-6174 74 cu
= C.)
PLEASE SIGN ON THE BOTTOM OF THIS FORM. a w
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Part B: Vehicle Maintenance Activity Monitoring Requirements .� ��
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Outfall Date 00556 00530 00400 o G oA
Oil and Grease �! Total Suspended Solids pH New Motor Oil usage,average gallons/month i 0
mg/I mg/I Standard units A alt
Benchmark 30 100 Within 6.0—9.0 U
KFI#1 10/31/19 <5 6.9
Note: If you report a sampled value in excess of the benchmark value,or outside the benchmark range for pH,you must implement Tier 1 or Tier 2 responses.
See General Permit text.
RECEIVED
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Date 10/31/2019 (first event sampled) JAN 30 2O2B NC Division of Environmental Quality
Total Event Precipitation(inches): 0.3"" Raleigh Regional Office
DENR-LAND QUALITY 3800 Barrett Drive
STORMvtiATER PERMITTING Raleigh,NC 27609
"I certi , 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),1 _/ ,,V (Date) i;2-'—/ /— / .7.

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
GENERAL PERMIT NO.: NCG180000 SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
CERTIFICATE OF COVERAGE NO. NCG180194 (This monitoring report is due at the Division no later than 30 days
FACILITY NAME : Klaussner Furniture Industries from the date the facility receives the sampling results from the
PERSON COLLECTING SAMPLES: Susan Feir laboratory.)
CERTIFIED LABORATORY: Meritech,Lab# 165 COUNTY Randolph
PHONE NO.( 336)625-6174
PLEASE SIGN ON THE BOTTOM OF THIS FORM. .,,
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Part B:Vehicle Maintenance Activity Monitoring Requirements c
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00556 00530 00400 o
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k.-: '- Oil and Grease Total Suspended Solids pH New Motor Oil usage,average gallons/month v ix
mg/l mg/I Standard units W W .4
(48 Q .oA
Benchmark 30 100 Within 6.0—9.0 �
S. r:
KFI #1 10/31/19 i 6.9 A ix
cd
U
Note: If you report a sampled value in excess of the benchmark value,or outside the benchmark range for pH,you must implement Tier l or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Date 10/31/2019 (first event sampled) NC Division of Environmental Quality
Total Event Precipitation(inches): 0.3"" Raleigh Regional Office
3800 Barrett Drive
Raleigh,NC 27609
"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)M , �I� _ (Date) I — /— / /