NCG090023 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG090000 SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
CERTIFICATE OF COVERAGE NO. NCG090023 (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.)
FACILITY NAME Engneered Polymer Solns. DBA Valspar ®COUNTY Iredell .
PERSON COLLECTING SAMPLE(S) REC IV PHONE NO. [phone]
CERTIFIED LABORATORY(S) Statesyil a Analytical Lab # '440 g2016
Lab # JAN (SIGNATURE OF PERMITTEE OR DESIGNEE)
Part A: Specific Monitoring Requirements
CENTRAL FILES By this signature, I certify that this report is accurate
DWR SECTION complete to the best of my knowledge
Outfalls> s
'No
4 k.�
Date >02701034'
SampleTotal
Collected . ;..�.
50050 01 `�
X01051
. Tot�al�� r r Total
Flow ,z, Cadmmm Ch omiuin;
Total
�iJea ! �
Total Flow
moYdd%,r.,MG;ugh:.
uy
0. ,.. �.
ug/1
1
12/17/15
<.001 mq <.003m
.003 m
m.il
�
" <.001 Mg .003 Mg
ona mg—
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes %(no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorine Requirements
Outfall `Date
No# 'Sample
Collectedf
000556���
500541
00530 3
00400
Total Flow
Oiland�
:t u.,
Grease
Notal
Sus endedOil
Solids•r
pH�<
izz.....,.
New Motor
Usage
.. , smo/dd/.' r "'6
M6,,—, ; ,
in%1 .. ,
m.il
�
al(mo K
STORM EVENT CHARACTERISTICS:
Date 12/17/15
Total Event Precipitation (inches): .76"
Event Duration (hours): 1
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Form SWU-255-072502
Page I of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
"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."
p�U�l/L
(Signature of Permittee)
I—i — Ap
(Date)
Form SWU-255-072502
Page 2 of 2