NCG120066 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS d or SAMPLES COLLECTED DURING CALENDAR YEAR:
e1• d� from
Certificate •f Coverage Nwuber: NCG d (Tlile monitoring report ahAil be received by the Division no later than 30 y
the date the facility receives the sampling re$ults from the laboratory.)
FACILITY NAMEi ''
�u �o ,� COUNTY
PERSON COLLECTING SANIPL�y(S) PH NE K0. $ 4 —
CERTHFIED LABORATORY(S) r0CP_ ykZ � Lab # CEIVED f 'EE OR DESIGNEE).
Lab # (SIGNAUMM OF PERMTIZ )
SAN U 6 2015 By tWs signature, I certify that this report is accurate
1
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of now motor oil per month? _ yes o
(if yes, complete Part B)
Part B: Vehicle MnintennncP Aelivity Mnntinrinv Rannlraniank
u c' 'li:'�;:
Outfall D u t
S P
No,:' . am le .
Collected
.. .. •
-
• ..
• . •
complete to the best of my knowledge.
'CENTRAL
:i�;r��,.;,� t
Part A: Specific Moidtoriug
Requirements
FILES
00400.—
.:r�
Total Flow
(if.appllcaUle); •
•'I.
-
DWR SECTION
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,
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_
Outfall Date • :. r
50050, ..
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Tgtal Total .� '•:i::_'. • ;r
�.77l�Sa:
'•F.
Collected
),low, if
a 1
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.�h�ehes 'i• .. ''lr�.' % •i•: ;�`•+'�7+ t.l?�,•.. i t' .. •.'.�L. .. __� .� -:r:'.
.. ' .F.- ....
1
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of now motor oil per month? _ yes o
(if yes, complete Part B)
Part B: Vehicle MnintennncP Aelivity Mnntinrinv Rannlraniank
u c' 'li:'�;:
Outfall D u t
S P
No,:' . am le .
Collected
.. .. •
-
• ..
• . •
,:
50050'"",-•`'
:i�;r��,.;,� t
.00556 ='r'',• .,.:
f.�.,; ...• 1:
� ,!., •,
00530' ,;.`,l•":A. Lti.
00400.—
.:r�
Total Flow
(if.appllcaUle); •
•'I.
-
+T ta1.�Ralni'�ll''f`
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.
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,
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Non -pot " �:,
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t ethdl��ltiG4 ;
A
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Total �;�;" f:� ;�
f".-. �lL 1,
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.: :.� {rd:
Solids;.,,z,,'.•`�{� x:
.rr> "t;•.t-�:•� si9 `.
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^l:: �;;•.. 1 r1..
.r;:.
q, ti•,�', i;r-', '. ,•
- '•'P.
'- 1 {' i y �•T':• `
';New Motor. Oil
U9oge
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Yrs A':. ',
"I{
oldd/ r
Inches . " tr. � `
r:4., :. ;..; �. `1x,r`.
}4.:,•. , �r, F't :'' gip.
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Units i ... ,
aVInO
Form SWU-246-062310
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date lfo,&—MI9-r .)4
Total Event Precipitation (hiches): 0
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 C iriginal and one copy to:
Divisic n of Water Quality
Attn: Gentral Files
1617 b lail Service Center
Raleie i. North Carolina 27699-1617
"I certify, under penalty of law, that this document and all attachments were prepared under my direction r 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 f r submitting false Information,
Including the possibility of fines and imprisonment for knowing violations."
s�
(Slgn6ture of Permittee)
Form SW -U-246-0623 10
Page 2 of 2