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HomeMy WebLinkAboutNCS000325 DMR SW (13)STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Permit Number NCS 0 0 0 3 2 5 FACILITYNAME Patch Rubber Company PERSON COLLECTING SAMPLE(S) Not applicable CERTIFIED LABORATORY(S) Lab # Lab # Part A: Specific Monitoring Requirements SAMPLES COLLECTED DURING CALENDAR YEAR: 2015 (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 SIGNATURE OF PERMITTEE OR DESIGNEE REQUIRED ON PAGE 2. Outfall Date 50050 00556 No. Sample Collected Total Total _ Flow (if app.) Rainfall pH COD Zinc Total Flow (if applicable) mo/dd/ r MG inches units mg/L Mg/L Non -polar O&G/TPH (Method 1664 SGT -HEM), if appl. 001 N/A New Motor Oil Usage x- 002 N/A m /l IIt , VP m /l unit al/mo NA 0 e� INFORMA 'J. 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 Activitv Monitoring Requirements Outfall Date No. Sample Collected 50050 00556 00530 00400 Total Flow (if applicable) Total Rainfall OR & Grease (if appl.) Non -polar O&G/TPH (Method 1664 SGT -HEM), if appl. Total Suspended Solids pH New Motor Oil Usage mo/dd/yr MG inches m /l m /l unit al/mo Form SWU-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 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) 6 —00 - ZD t -S (Date) The Facility was unable to collect the required samples from a "Representative Storm Event" for the month of May 2015. "No Flow" Form SWU-247, last revised 2/2/2012 Page 2 of 2