NCS000373 DMR SW (4)

STORM WATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
Permit Num!er - 's• SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(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 COUNTY Stanly
PERSON COLLECTING SAMPLE(S) Heather Ashby PHONE NO.( 704 )474-8136
CERTIFIED LABORATORY(S) Pace Analytical Lab Lab# PASI-C
Pace Analytical Lab Lab# PASI-A
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
Outfall Date3,-33,; 359650,:.,:':5.
No Sample Total Total 33 ;3Oil&Grease pHr :COPY
„ ' : "1,
mgll Std Units: :
SDO1 08/02/16 N/A 0.25 ND 6.0 29 RECEIVED
SDO2 08/02/16 N/A 0.25 ND 6.3 105
AUG 2 9 2016
CENTRAL Fll FS
DWR SECTION
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 Activity Monitoring Requirements
Outfall Date ,,50050: , ,00556 ;,00530V-' 00400
No Sample Total Flow Total PO;&Oreaie 7'1Total pH NOW Motor
Collected (if applicable) Rainfall (if appi) O&G/TPH Suspended . Oil Usage
Method 1664 Solids =
appl
'unit
Form SWU-247,last revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date 08/02/2016 Attn:Central Files
Total Event Precipitation(inches): 0.25 1617 Mail Service Center
Event Duration(hours): (only if applicable—see permit.) Raleigh,North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation(inches):
Event Duration(hours): (only if applicable—see permit.)
"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,
7....including th ossibi ity of fines and imprisonment for knowing violations." ,
(Signature of Permittee) (Date)
Form SWU-247,last revised 2/2/2012
Page 2 of 2