HomeMy WebLinkAboutNCS000567_2021 DMR_20211203STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000567
FACILITY NAME ECOFLO, Inc.
PERSON COLLECTING SAMPLE(S) Preston Black
CERTIFIED LABORATORY(S) Pace Analytical Lab 9
Lab N
Part A- Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2021
(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.)
COUNTY Guilford
PHONE NO. (336 )617-2714
SIGNATURE OF ?ERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2. 1
Does this facility perform Vehicle Maintenance Activities using more than 5 5 gallons of new motor oil per month? Oyes Ono
(ifyes, complete Part B)
Part B: Vehicle Maintenance Aetivitv Mnnitnrina Rpniiirpmpnt�
Outrall
Nn.
Date
Sample
Collected
50050
00556
OOS30
00400
Total Flow
(itapplicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non-pol2r
O&GITPH
(Method 1664
SGT-REM), if
app.
Total
Suspended
Solids
PR
New Motor
Oil Usage
mo/dd/yr
mr,
inches
mg/l
mg/1
unit
I gaumo
Form SWU-247, Iasi revised 611212015
Page I of2
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division ofEnergy Mineral and Land Resources
Date NIA Attn: Central Files
Total Event Precipitation (inches). 0 1617 Mail Service Center
Event Duration (hours): N/A (only if applicable — see permit.) Raleigh, North Carolina 27699-1617
(if more than one storm event was sampled)
Date NIA
Total Event Precipitation (inches): 0
Event Duration (hours)- N/A (only if applicable —see permit.)
'.1 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 submitt�d is, to the
best ofmy knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
inclu7dingth 7-bility Wrri nd mprisonment for knowing violations."
10/2812021
(rre of Permittee) (Date)
Form SWU-247, last revised 611212015
Page 2 of`2