NCG100076 DMR SW (3)

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE N0 'NCG�100 .7 6 SAMPLES COLLECTED DURING CALENDAR YEAR:JUNE 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 S&R AUTO &'-TRUCK SALVAGE COUNTY MEI(yJ T.FNRTTR(
PERSON COLLECTING SAMPLE(S) BRYANT HORTON OR LISA FRYE �UR/ED PHONE NO.(704 )597-1085 `
CERTIFIED LABORA TORY(S)
Lab ' JUL. 0 5 2016 PLEASE REMEMBER TO SIGN ON THE REVERSE--)
Part A:Stormwater Benchmarks and Monitoring Results CENTioA I '
FILES
DwR SECTION ,
_ For sampling periods with no discharge,you must submit this discharge monitoring form noting"No Flow"or"No Discharge"within
30 days of the end of that period to comply with permit reporting requirements.
:Outfall: :;-'‘'''::.4,';. _ -.:..,�a . - . , "''"M"r ';')-;;; r::-. 771:123 ^_ Mrd:.;,
Date ;}��0040Q� 00530:, �;-�� i• 01051;x`-;��• ��,=��7,8141�x�r �
_ ��, vis .,r:a: �. -, �'
Sam le Collected= 'Total T 'q-T-4,0,2: Total Suspended -Non pof4I t= '"-Ethylene'Glycol, _ Lead,fTotal ,liii alroxu
mo/dd/yeas Rainfall, , Standard Solids;(TSS) O&G/T ` »" Recoverable

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
waive onitoring of
toxic
cs. The
ent
Facilities that incorporate a solvent management plan into the Stormwatersed and the other elements listed in theollution Prevention Plan may reqest hGenDeraQlat PermitmFor those facilities lallowed sulch a waiver,the
management plan shall include a list of the total toxic organiccompounds u
discharger shall sign the following certification statement:
Solvent Management Plan Certification Statement
ring requirement for total
"Based upon my inquiry of the person or persons directly responsible or managing
organics into the stormwater or compliance with the ermit oareas which are exposed to�ainfalorgan
l orics(TTO),I
certify that to the best of my knowledge and belief,no dumping of concentrated
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent
management plan included in the Stormwater Pollution Prevention Plan."
Name(Print name)
Title(Print title)
Signature
Date
Mail Original and one copy to:
Division of Water Quality
Attn:Central Files
1617 Mail Service Center
• Raleigh,North Carolina 27699-1617
"Irepared
der my direction or
ervision in
ccordance with a system designed
o
sure under penalty of nel thap thly document evaluate the informand all attachments tion re submitted. Bas d on my inquiry of the person aor persons who manage the system,or
assure that qualified personnel properly gather and
those persons directly responsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete.
am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
, J 041 I�j�{l✓ ' � (Date)
(Sign Lure of Permittee or Designee) "`
J
Form SWU-251,last revised October 25,2012
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