NCS000456 DMR SW (2)

Permit Number NCS OQQ) 2+ cc�- L
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 9015
(Thus monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling res►dts from the laboratory.)
FACILITY NAME CQVe. Cc�y �& P�-e� ui�,� COUNTY C-¢-Au'Y--N
PERSON COLLECTING SAMPLE(S) -n Y-�n Y2AI.yn PHONE NO. (an Ej Le
CEItTIF11:DLA130RATORI'(S),S1'1,eA•ly Znv SAn— Lab# �`-xchnrGEjVE[:)
Lab #
JUL 15 2015 SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
tart A: Specific 1llonitoring RequirementsCENTRAL FILE
DWR SECTION
F )ate
Sample
Collected
Total
Rainfall
Does this facility pertbrm Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes v no
(il•yes, complete Part 13)
Form SWU-247, last i-crised 212120 12
Page I ofx 3

STORMWATEIt DISCIIARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS O Q O J 5 L
FACILITV Nz%A,IE czs ue C►-�, w�& PQ4z,QI24,;n
PEIZSON COLLECTING SAA'I]'LE(S) Y2A1.WY1
CERT.iF1ED I,AUOItATO1t)'(S) c5V-,eA-t�l Zn V &cfL Lab # -
Lab #
fart A: Specific Nloniforing Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR:
(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 C -Q-A L) -' 1 -
PHONE NO. (_ S) Ln
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
ontr:�n nate
No. Sample
Collected
q�l�oSp�o�¢.u5 atrzs►L C,hrsor++�txrr� CQ+Ape-!L
uu►hld/yr
M/ 1 rv,-zr! r 1 m8 1
poen this facility pedbrni Vehicle; Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes "14 no
(il'ves, complete Part 13)
Form S bW--2 47, last re �,ised 2/2/21112
Pagc\ofv 3
a

Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date
No. 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
mo/dd/yr
MG
inches
m /I
m /I
unit
al/mo
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. I am aware that there are significant penalties for submitting false
infef 1hption, including the/possibility of flues and imprisonment for knowing violations."
71t
of Permittee) (D te)
Form SWU-247, last remised 2/2/20/2
Page � ofx
'3 3