NCS000208 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Ar. .
Permit Number NCS0zn 0,10 x SAMPLES COLLECTED DURING CALENDAR YEAR: !V
(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.)
M, FACILITY NAME , b 11 i0rV © eqN �P/mNod ISLenr1� /e0c)in f - COUNTY �icc/IJcu/G C
PERSON COLLECTING SA PLE(S) i PHONE O. (9ZO y,S7_
CERTIFIED LABORATORY(S) b #�� v- C LaECEIVE®
Lab #- (SIGNATURE OF R DESIGNEE)
SEP 2 8-2015 By .this signature, I certify that this report is accurate
Part A: Specific Monitoring Requirements - _ - CENTRAL FILES. - complete � to the best of my knowledge..
r11A10 Q1=f T1nKi
uoes tnts iacuity perform vehicle Maintenance Activities using more than 55 gallons -of new motor oil per months — %t no
(if yes, complete Part B) yes —
Part B: Vehicle Maintenance Activitv 11i nnit.,v:.,.,
Outfall Date
No. Sample
Collected
50050
Total Flow
(if applicable)
Total
Rainfall
00556
Oil & Grease
(if appL)
Non -polar
O&G/TPH
(Method 1664
SGT -HEM), if-
aI.-
00530
Total .H
Suspended_
Solids
00400 -
p
New Motor
Oil Usage
mo/dd/ r
MG
inches
m
m
unit
aUmo
Form SWU-247-062310
Pagel of 2

STORM EVENT CHARACTERISTICS:
Date 0$' 3/ x015
Total Event Precipitation (inches): O. 38"
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
Aun: 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." '
20 5
(Date)
Form SW U -247 -062310
Page 2 of 2
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