NCS000321 DMR SW (15)

PERMIT COVERAGE NO. Nf'S00.00
FACILITY NAME Lubrizol-Gastoma
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Prism Labs
Part A: Specific Monitoring Requirements
STORMWATER DISCHARGE OUTFALL (SDO)
ANALYTICAL MONITORING REPORT
Lab #
Lab #
402
Outfall
No.
Date
Sample Total
Collected Flow
Biochemical
Oxygen
Demand
Total Chemical Zinc pH
Suspended Oxygen
Solids Demand
mm/dd/yr MG mg/1
mg/I mg/I mg/I
02
1/19/2016
5.1
8.9 <50 0.19 7.54
Total Flow
Oil and Grease
Lead, Total
Detergents
pH
New Motor Oil
Collected
Recoverable'
(MBAS)`
Usage
mm/dd/yy
MG
mg/I
ug/1
mg/1
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(all samples collected during a calendar year, shall be reported no later
than 30 days from the date the facility receives the sampling results)
COUNTY Gaston
PHONE NO. 70 15-4165
(SIGNATURE OF PERMITTEE OR DESIGNEE)
PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge
Outfall
Date
50050
00556
01051
38260
00400
No.
Sample
Total Flow
Oil and Grease
Lead, Total
Detergents
pH
New Motor Oil
Collected
Recoverable'
(MBAS)`
Usage
mm/dd/yy
MG
mg/I
ug/1
mg/1
unit
gal/mo
STORM EVENT CHARACTERISTICS
Date 1/18/2016
Total Event Precipitation (inches):
Event Duration (hours): 72
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
0.78
REFC fi�-- �
MAR o,8
2016
CE'VTp,�L FILES
C1l,R S6071 V
Yes X No
Attn: Central riles
DEHNR
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Form MR18
Page 1 of 2

Footnotes:
1 Applies only for facilities at which fueling occurs.
Z Detergent monitoring is required only at facilities which conduct vehicle cleaning operations.
"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."
(Signature of Permittee)
a 114
(Date)
Form MR18
Page 2 of 2