NCS000325_COMPLETE FILE - HISTORICAL_20190318

• - STORMWATER DIVISION CODING -SHEET...
RESCISSIONS
PERMIT N0..
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COMPLETEFILE=HISTORICAL
DATE OF
RESCISSION
❑ �V � � U I J /
YYYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
0 HISTORICAL FILE
DOC DATE
❑
YYYYMMDD

F E HR GRAff 'I H�
ENGINEERING & ENVIRONMENTAL
UPS Tracking Number: 1Z 651 395 03 5727 1088 RE1
FD
MAR 1 8 2019
March 5, 2019
CIE i'! i i•G` FILES
Division of Water Quality
l,'lr1R ._C.
,ET10N
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - February 2019
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Storm Water Discharge Outfall (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for February 2019.
(i Please note the following:
• The facility was not able to collect the required samples from a "Representative
CL Storm Event" for the month of February 2019.
• 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,
TJt-&M
Amy L. rimble, CHMM
Environmental Scientist
ALT: mns
Enclosure
cc: Mr. Marto Carter, Patch Rubber Company (with enclosure)
0:IPatch Rubber Company119-1051PA Final119-105 NC Div of Air - 2019.03.05 - Storm Water SDO February 2019.docx
221 E. Main Street I Suite 200 I Freeport, IL 61032 1 p:815.235.7643 I f:815.235.4632 I www.fehr-graham.com
Insight. Experience. Results.

STORMNYATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITY NAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab 4
Lab N
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2 019
(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.)
COUNTY Halifax
PI-IONENO. 2( 52)536-2574
SIGNATURE OF PER.MITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
50050
Total
Flow ifa
Total
Rainfall
pH
COD
Zinc -
mo/dd/vr
MG
inches
units
mg L
mg L
001
N/A
002
N/A
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 Monitorinp, Requirements
Outfall
No.
Date
Sample
Collected
50050 1
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), if
app'.
Total
Suspended
Solids
pH
New Motor
Oil Usage
moldd/vr
I MG
inches
aign
mW 1
unit
gal/mo
Form SWU-247, last revised 21212012
Page 1 of 2

-'Rgt1r.
STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): N/A
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
"Total Event Precipitation (inches):
Event Duration (hours); (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Ann. Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"t certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accprdance with a
system designed to assure that qualified personnel property gather and evaluate the information submitted. Based an 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 nf.my knowledge and ef, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possiiiilio lines and imprisonment for knowing violations."
CI 2
kl q
(Signatur f Permittee) (Date)
T, WFacility was unable to -collect the required samples from a "Representative Storm Event"
liar the month of February 2019 "No Flow"
Form SWLJ-247, last revised 21212012
Page 2 of 2