NCS000325_COMPLETE FILE - HISTORICAL_20190411

STORMWATER D1VI510N 60DING -SHEET-..- .
RESCISSIONS.
PERMIT N0.
DOC7YPE
1� COMPLETE FILE =HISTORICAL
DATE OF
RESCISSION
❑ � � I � � l I I
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000325
FACILITY NAME Patch Rubber Company
PERSON COLLECTING SAMPLE(S) Not applicable
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
(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
PHONE NO. 2( 52 )536-2574
iREO
ATURE OF PERMITTEE OR DESIGNEE
UIRED ON PAGE 2.
Outfall
Date
Sample
ollected
II 1
TotalNo.
Rainfall
11
`
11
"
w
FENTRAL
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
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH-
New Motor
-Oil Usage
moldd/vr
MG i
inches
m
m /l
unit
gallmo
Form S WU-247, last revised 21212012
Page 1 of 2

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
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 4'6nilficd`per-soniiel propefly g—ntlier.and'eva'16ate'the informntion submitted: Based on my Inquiryof the person
or persons who mattiage the ern, nr;those persaris dlreclly:res}�anslble. for gatFicring:thc;lnformatlon, theinformatlan submitted is, to the
best ormy,know_ led` Is cf; true, aecuia#e, sled complete: I i'in aware that there "ere slgril[Icanfpenaitles for submitting false Information,
Including the ility ncs:and ltnprisonment for knowing vialationA"1-5
The Facility was unable to collect the required samples from a "Representative Storm Event"
For the month of March 2019 "No Flow"
Form SWU-247, lost revised 21212012
Page 2 of 2

FEHRGRAt"',�M
ENGINEERING & ENVIRONMENTAL
UPS Tracking Number: 1 Z 651 395 03 5711 8502
April 3, 2019
North Carolina Division of Air Quality
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Storm Water Discharge Outfall (SDO) Monitoring Report - March 2019
Patch Rubber Company
100 Patch Rubber Road
Weldon, North Carolina 27870
NCS000325
Dear Sir/Madam:
Enclosed please find the Stormwater Discharge Outfalt (SDO) Monitoring Report for storm
water discharge from the above -referenced facility for March 2019.
Please note the following:
• The facility was not able to collect the required samples from a "Representative
Storm Event" for the month of March 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,
a -rot TA�)YnU-0
Amy L. Trimble, CHMM
Environmental Scientist
ALT:mns
Enclosure
cc: Mr. Marto Carter, Patch Rubber Company (with enclosure)
0:1Patch Rubber Company119.1051PA Finai119-105 - NC Div of Water Quality - 2019,04.03 - Storm Water SDO March
2019.docx
221 E. Main Street I Suite 200 1 Freeport, IL 61032 1 p:815.235-7643 I f:815.235.4632 I www.fehr-graham.com
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