NCS000528 DMR SW (2)

Permit Number: NCS 000528
Certificate of Coverage Number: NCG
FACILITY NAME Premiere Fibers
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Pace
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
T. Havnes
Part A: Specific Monitoring Requirements
or
SAMPLES COLLECTED DURING CALENDAR YEAR: 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 Anson
PHONE NO. [phone]
Lab # 633
Lab # (SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, l certify that this report is accurate complete to
the best of my knowledge.
Outfall Date
,,No. Sample
.. Collected
x
w
Total
Rainfall ,;
-Total
Suspended
Solids (TSS)
COD
pH
%+
_
Permit.Bench
N/Al
10.0 .,
420. ,
6-9 ..
;. mo/dd/yr .
inches
mg/l
w. mg/l
Units
1 5.1.15
See Below
ND
NA
6.5
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)
Form SWU-246-112608
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements
.. Outfall:
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STORM EVENT CHARACTER18TICS:
Date 5.1.15
Total Event Precipitation (inches): 0.12
Event Duration (hours): N/A
(if more than one storm event Nvas sampled)
Date N/A
Total Event Precipitation (inches):
Event Duration (hours):
(only if applicable — see permit.)
(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 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."
Sign re of Permittee
!�5!b
'Date
Form SWU-246-112608
Page 2 of 2