NCS000452 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NC�_4 —9 or SAMPLES COLLECTED DURING CALENDAR YEAR: ao14
Certificate of Coverage Number: NCG (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.)
FACILITY NAME C, t iC.tQ1 L4q- X IrAe�1
PERSON COLLECTING SAMPLE S) 'il Mo
CERTIFIED LABORATORY(S) Lab RECEIVE
Lab #
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total Total
Collected Flow (if app.) Rainfall
MG I inches
COUNTY_
P30NE NO.
JAN 12 2015By
CENTRAL FILES
CO1D Total
Suspended
Solids (TSS) 5
TURE OF f ERM1rMICI E OR DESIGNEE)
signature, I certify that this report is accurate
e to the best of my knowledge.
PH
0-9— L.
Cry PP°4,z-
Units 1 v -a TZ--
Does
L
Does this facility perforin 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 Artivitv Mr,» it.wi.,.. uo.....
[6—uitfa-117
No.
Date 50050
Sample Total Flow
Collected (if applicable)
mo/dd/ r MG
00556
00530
Total Rainfall
inches
Oil & Grease
m
Total
Suspended
Solids
m
00400
pH New Motor Oil
Usage
Form S W U-2=46-1 1 26021
Page I of 2

STORM EVENT CIIARACTERISTICS:
Date
Total Event Precipi tion (inches):
Event Duration (hours (only if applicable — see permit.)
(if more than one storm event s sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only il 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,
"ding the possibility of fines and imprisonment for knowing violations."
of
11 -711r ---
(Date)
Form S W U-246-1 12608
Page 2 of 2