HomeMy WebLinkAboutNCS000005 DMR SWSTORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 00000 S 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.)
FACILITY NAME U rv\ i CO R E TO C AT A t y 57 C C C U
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) -ra L Lab # 11 31,
i1Ggp)eWT oNE Lab 604, DW A3 -7T$$
Part A: Specific Monitoring Requirements
COUNTY/ ECENEQ
PHON 0 -d
(SIGNATURE OF PERMITTEE OR DESIGNEE) .IAN
By this signature, I certify that this report is accurat
complete to the best of my knowledge. CENTRAL IEILIP
DWR SECTION
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes X40
(if yes. complete Part B)
Part B: V6111e16
Outfall
No.
Daa
ivify ivioruEoring
ne uwtlulyi4w
.
00636
WSW
00401 •
Total Plow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
0&G11TH
(Method•1664
$GT -HEM), if
a 1.
SamplePOPE
1
1
G
noMEMNON
m
m-gilunit
Umo
rM
c.
• •
, .
, .,
, ,
...
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes X40
(if yes. complete Part B)
Part B: V6111e16
Outfall
No.
, intenance Ac
I to
Sample
Collected
ivify ivioruEoring
ne uwtlulyi4w
.
00636
00'530
00401 •
Total Plow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
0&G11TH
(Method•1664
$GT -HEM), if
a 1.
Total
Suspended
Sollas
pH
New Motor
Oil Usage
G
inches
m
m-gilunit
Umo
Form SWU-247-062310
Page 1 of 2
STORM EVENT CHARACTERISTICS: Mail Original -and -one copy to:
Divi-sion4f Water Quality
Date r / - zL " I q Atnu Central -Files
'yQEaf i e xeclpltntiQi} (inches): t y 5 1617- U161 Service. Cento r
Lvent Duration (hours): (oiily if applicable — see permjt,) Raleigh, North Carolina 27699-1617
(if more than one storm event was sampled)
D04
Tot�ll-)61i+etili=Precl�itntf�(i ('1ns�I►�):--�_---
Dtsegt •IiNAff (11%uras (001Y if ftltcdble — gee pbrmit..)
cprtify,uadQr-ponalty oP law: that this documentand all-aftuefiments were prepared under my directiort or supervialon in accordance with a
system 40ped to aespre-that cluallhad ei=sonnel ' j'�e' I gatiter and evaluate the -information suGrtittcd: -Based'ou my loquiry of the pexeon
b getdsans wfio ma�taggp Che system, or ose persons dlrectiy tespons;16] tor -gathering the inf4rmatlon, Bite iiif4l't1 tlon:submitt@d is, to the best
off -bi I cage atiil bif ef, Prue, ac'curafe, and edntplefe.. 1C am -aware: Qia't there are significant penalt{e� eor-submittiAg false information,
'lndli idirig tiro p'ossi ty-of fines and timprisonment fuer knowing violations."
• Dl - /5-_ I_S
(ElgadulFe of Permittee) (Date)
Form SWU-247-062310
Page 2 of 2