NCS000373 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS000373 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.)
FACILITY NAME Michelin Aircraft Tire Company, a Division of Michelin NA Inc
PERSON COLLECTING SAMPLE(S) Heather Ashby
CERTIFIEDLABORATORY(S) Pace Analytical Lab Lab# 922798140RECEIVEur"
Pace Analytical Lab Lab# 92279814002 A N
262016.
Part A: Specific Monitoring Requirements
CENTRAL FILES
DWR SECTION
COUNTY Stanly
PHONE NO. ( 704 ) 474-8136
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2. 1
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SDOI 12/14/15 N/A 0.25 ND 6.6 31
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SD02 12/14/15 N/A 0.25 43.3 6.9 54
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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)
Part B: Vehicle Maintenance Activity Monitorin Requirements
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Form SW247, last revised 21212012
Page] of

STORM EVENT CHARACTERISTICS:
Date 12/14/15
Total Event Precipitation (inches): 0.25
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 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 ssibility of fines and imprisonment for knowing violations."
1/.20/14
(Signature of Permittee) (Date)
Form SWU-247, last revised 2/2/2012
Page 2 of 2