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Certified Mail No. 7015 0640 0003 0331 5026 � R-12 ` _, A��N AG
Return Receipt Requested -•
July 11, 2016 -.•y An- 18 2016
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Division of Water Quality = 4` , "" CENTRA, F�
�3w �wR LES
Attention: Central Files �, SECTlCN
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - June 2016
Patch Rubber Company
100 Patch Rubber Road
Weldon, NC 27890
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above-referenced facility for June 2016.
Please note the following:
0
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of June 2016.
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• The facility will continue monthly collection of storm water samples for analysis.
If you have any questions regarding these documents, please do not hesitate to contact
this office.
Sincerely,
armt T
Amy L. Trimble, CHMM
Environmental Scientist
ALT:dld
•
Enclosures
cc: Mario Carter, Patch Rubber Company
0:\Patch Rubber Company\16-105\Final\ALT 16-105-Storm Water SDO June 2016 Cover Letters.docx
221 E.Main Street I Suite 200 I Freeport,IL 61032 I p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight.Experience.Results.

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STORMWATER DISCHARGE OUTFALL(SDO)
k MONITORING REPORT
Permit Number 1 eSxa0. - ,--,, 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 Patch Rubber Company COUNTY Halifax
PERSON COLLECTING SAMPLE(S) Not applicable PHONENO.(252 )536-2574
CERTIFIED LABORATORY(S) Lab#
Lab#
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A:Specific Monitoring Requirements
Outfall Date 50050 . - -
No. - Sample ' Total Total -
Collected Flow(if app.) Rainfall • pH . - COD Zinc
mo/dd/yr MG inches units mg/L mg/L
001 N/A
002 N/A
RECEIVED
JUL 18 2010
CENTRAL rfLES
JWR SECTION
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?' yes Xno
(if yes,complete Part B)
Part B:Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 - ` 00530 00400 •
No. Sample Total Flow Total Oil&Grease Non-polar Total pH New Motor
Collected (if applicable) Rainfall (if appl.) O&G/TPH Suspended Oil Usage
(Method 1664 Solids
- SGT-HEM),if
appl• -
mo/dd/yr MG inches mg/1 mg/1 unit ' gal/mo
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 Attn:Central Files
Total Event Precipitation(inches): N/A 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 t .' qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage t system,or those persons directly responsible for gathering the information,the information submitted is,to the
best of my knowledge a '+ belief,true,accurate,and complete. I am aware that there are significant penalties for submitting false information,
including the possibil'. of fines and imprisonment for knowing violations."
/• 44
(Signature of ermittee) (Date)
The Facility was unable to collect the required samples from a "Representative Storm Event"
for the month of June 2016. "No Flow"
Form SWU-247,last revised 2/2/2012
Page 2 of 2