NCS000336 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS -10-0-0 33 6
FACILITYNAME UFP Elizabeth City, LLC
PERSON COLLECTING SAMPLE(S) Adam Fritz
CERTIFIED LABORATORY(S) Pri Fan amd NPmho Lab #
Lab #
Dn,•, A • Cnarirr Mnnitorina Reauirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014-2015
(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 Pa guotank
G PHONE N )3 3 8- 2
RECD I Y```' SIGNATU F PERMITTEE OR DESIGNEE)
MAY 18 2015 By this signature, I certify that this report is accurate
complete to the best of my knowledge.
rENTRAL FILES
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)
Outfall Date 51111511 I IV VdJ V
No. Sample Total Flow I Total IOU& se
Collected I (if applicable) Rainfall (if appl.)
Non -polar Total
O&G/TPH Suspended
(Method 1664 Solids
SGT -HEM), if
PH New Mott
Oil Usage
Form SWU-247-062310
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STORM EVENT CHARACTERISTICS:
Date NA
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 system, or those persons directly responsible for gathering the information, the information submitted is, to the best
of my knowledge be true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including ib' ' o nes and im risonment for knowing violations."
(Signature of Pe 'ties) (Date)
Form SWU-247-062310
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