NCS000133 DMR SW (2)

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
GENERAL PERMIT NO.NCQ OK000U 1('( 0( J 1 3. ...... SAMPLES COLLECTED DURING CALENDAR YEAR• 2015
/��/ v (all samples collected during a calendar year,shall be reported no later
FACILITY NAME Jowat Corporation than January 31 of the following year)
FACILIT''Address PO Box 1368 High Point,NC 27261 COUNTY Randolph
PERSON COLLECTING SAMPLE(S) PHONE NO [phone]
CERTIFIED LABORATORY(S) R&A Laboratories,Inc Lab# 34
Lab# (SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature,I certify that this report is accurate and
complete to the best of my knowledge.
Part A:Specific Monitoring Requirements-Analytical Monitoring
50050 00545 00400
Date Total
Outfall Sample Total Suspended
No. Collected Flow Solids pH RECFIVED
mo/dd/yr MG mg/I unit
001 04/15/15 73.3 5.98 JUN 0.3 2015
002 04/15/15 12.4 5.68
003 04/15/15 15.2 5.81 DVVR SECTION
004 04/15/15 15.8 5.79 INFORMATION PROCESSING UNIT
Part B:Visual Monitoring Requirements
Date
Sample Floating Suspended
Outfall Collected Color Odor Clarity Foam Oil Sheen Other
Solids Solids
No. mo/dd/yr
001 04/15/15 Dirty None Not Clear Yes Yes No N/A Sediment in
bottom
002 04/15/15 Clear None Semi-Clear Yes None No N/A Grass in water
003 04/15/15 Dirty None Not Clear Yes None No N/A
004 04/15/15 Dirty None I Not Clear No None No N/A
STORM EVENT CHARACTERISTICS:
Date 4/15/2015
Total Event Precipitation(inches): 0.31 Mail Original and one copy to:
Event Duration(hours): 9 Attn: Central Files
DEHNR
(if more than one storm event was sampled) Division of Environmental Mgt.
Date P.O.Box 29535
Total Event Precipitation(inches): Raleigh,NC 27626-0535
Event Duration(hours): _
(if more than one storm event was sampled)
(if more than one storm event was sampled) Date
Date Total Event Precipitation(inches):
Total Event Precipitation(inches): Event Duration(hours):
Event Duration(hours):
Form MR-18
Page 1 of 2

Footnotes:
"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 inquirey 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) (Date)
Form MR-18
Page 2 of 2