NCG030652 DMR SW

STORMWATER DISCHARGE OUTFALL(SDO)
CG-0 -0..,., . cs? e MONITORING REPORT
Permit Number:NC or SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
Certificate of Coverage Number:NCG030000 (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 Carolina Laser Cutting COUNTY Guilford
PERSON COLLECTING SAMPLE(S) Chasity Hart r—Re y PHONE NO. 36j 292-1474—
CERTIFIED LABORATORY(S)_R&A Laboratory Lab# 34 l �/ D
Lab# JAN 2 3 2017 (SIGNATU OF I✓RMITTEE OR DESIGNEE)
By this signature,I certify that this report is accurate
�'ENTRA�. FILES complete to the best of my knowledge.
Part A: Specific Monitoring Requirements "Mg? SECTION
Outfall Date 50050
No. Sample Total Oil&Grease pH TSS Copper Lead Zinc
Collected Flow
mo/dd/yr MG mg/I Std units mg/I mg/1 mg/1 mg/1
1 12/6/2016 0.056 <5 6.38 19.0 0.012 <0.005 0 072
2 12/6/2016 0.056 <5 5.66 64.4 0.010 <0.005 0.219
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes X _no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No. Sample Total Oil& Grease Total pH New Motor
Collected Flow Suspended Oil Usage
Solids
mo/dd/yr MG , mg/1 mg/1
Form SWU-246-051100
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date 12/6/16 Attn• Central Files
Total Event Precipitation (inches): 0.375 1617 Mail Service Center
Event Duration(hours): 2 Raleigh,North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation(inches):
Event Duration (hours):
"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) (Date)
Form SWU-246-051100
Page 2 of 2

TTO sampling waiver (per NCG030000 Part II Section A):
"Based upon my inquiry of the person or persons directly responsible for managing compliance
with the permit monitoring requirement for total toxic organics (TTO), I certify that to the best of
my knowledge and belief no leak, spill, or dumping of concentrated toxic organics into the
stormwater or onto areas which are exposed to rainfall or 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. "
IlliA # /3rG14yy I--M-/ 7
Name (type or print) Date
, / -e,z--1-i-ii"--. ------------
ignature
Carolina Laser Cutting
4400 South Holden Road
Greensboro, NC 27406