NCS000541 DMR SW (3)

4- - 1
STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
Permit Number N . SAMPLES COLLECTED DURING CALENDAR YEAR: r"� ,*
(This monitoring report shall be received by the Division no later tha 30 days from
I t^ 11 11 the date the facility receives the sampling results from the laboratory.)
FACILITY NAME Sw'�Q
otn S k LouirAe.r1-arr rer4, �w p)G,J' ��77
COUNTY f ,0be5or\
PERSON COLLECTING SAMPLE(S) Gro ch Li Cob so(.1 PHONE NO.(q I O) X1-13- 41-15(0
CERTIFIED LABORATORY(S) 6 S - (si6 ' -< Q v)czn Lab# NC.D I$7 3
Lab# (SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature,I certify that this report is accurate
' complete to the best of my knowledge.
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total Total 800 COO Ammool0, aS To i jvi1ro,� ki'J Jv 4r�4�(
Collected Flow(if app.) Rainfall 1j M N,4- , k_
.13ier,6n rV? mo/dd/yr MG inches O rn JL 1a0 1-7)1 4- -7.2 L 3O, /L 20m1C I L 10m311---
i pm3J
Doc oI/Ig/ I(, 3, `? —2,0 13,i <, z.5 ,2, IQ O,c, f ,Sa
DFr :,;" 1,‘,1E0
FEB f.R 'alb
rsr:NITRAl_ FILES
DWR SECTION
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes _no
(if yes,complete Part B)
Part B:Vehicle Maintenance Activity Monitorin Requirements
Outfall Date 50050 J 00556 00530 00400
No. Sample Total Flow Total Oil&Grease Non-polar . Total pH New Motor
Collected ; (if applicable) Rainfall, • (if appl.) ' _ 08‘q - ' • r-Suspeieded Oil Usage
- • f ' •(Method 1664- Solids
SGT-ISM),if
appl•'
mo/dd/yr MG inc e g/1 mg/I unit,,. gal/mo
Form SWU-247-062310
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date Attn:Central Files
Total Event Precipitation(inches): 1617 Mail Service Center
Event Duration(hours): (only if applicable—see permit.) Raleigh,North Carolina 27699-1617
(if more than one storm event was sampled)
•
Date
Total Event Precipitation(inches):
Event Duration(hours): (only if applicable—see permit.)
•
"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. 1 am-aware;that there nire significant penalties for submitting false information, .'
including the possibili of fines and imprisonment for knowing violations:" • i .
Z
(Signature of Permittee)— (Date)
"1."-
Form SWU-247-062310
Page 2 of 2