NCS000222 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS ©QZ)o��� o' S or
Certificate of Coverage Number: NCG
FACILITY NAME `41JZQ I nf1 Q
PERSON COLLECTING SAMPLES (�
CERTIFIED LABORATORY(S) 5 U Lab #tea
Lab# �lS�
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: a- N
(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
RECEIVE
JAN 12 2015E
CENTRAL FILES
1
TUBE OF PERMITTEE OR DESIGNEE)
signature, I certify that this report is accurate
e to the best of my knowledge.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
(if yes, complete Part B) _yes no
Part B: Vehicle Maintenance Activit Monitorin Re uirements
Outfall Date 50050 00556
No. Sample Total Flow Total Rainfall Oil & Grease
Collected (if applicable) - -
MG inches
00530 00400
Total pH New Motor Oil
Suspended Usage
Solids
Form S W U-246- l 12608
Page I of��

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS Q (Z__'J0 Pao� or
Certificate of Coverage Number: NCG
FACILITY NAME CoLfLDA) ` )0_ Ckl P,_ L
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total Total
Collected Flow (if app.) I Rainfall
MG finches
SAMPLES COLLECTED DURING CALENDAR YEAR: ao
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receive the sampling results from the laboratory.)
COUNTY�1� Yi SL -v 1
(
P ENO. O) "71.
( ATURE + PERMIT lEE OR DESIGNEE)
By his signature, I certify that this report is accurate
coi plete to the best of my knowledge.
<o.ccl I _<0 -.6
v. I `
<c�•oo5 <GJ.00S P.Z,0Q <O.pp
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per months _yes
(if yes, complete Part B) —no
Part B: Vehicle Maintenance Activity MonitorI Rec ui
Outfall
No.
Date
Sample
Collected
moldd/ r
50050
00556
00530
Total Flow
(if applicable)
MG
Tota fall Oil & Grease
inches In
Total
Suspended
Solids
ro
00400
pH New Motor Oil
Usage
Form S W U-246-1 12608
Page"),of', `t

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS C)c) J",�afl. or
Certificate of Coverage Number: NCG
FACILITY NAME %k�A
,
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total Total
Collected Flow (if app.) Rainfall
MG finches
SAMPLES COLLECTED DURING CALENDAR YEAR: '2p#,
(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.)
COU Y
PH(fNA NO. (ct. t a 7Z-)1 - '2 sa 1
(S1G- PURE z5F P�my
""1'EE OR DESIGNEE)
By ' signature, I tify that this report is accurate
co► ete to the best knowledge.
X�)lenQ"
��se.
.J00556
T'K h %loi 1 r)
n
mg/l-------F
m
,
!t L h L
r. --, rt
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 - VPhirla IViaintannnnn A..t:.,:
Outfall Date
No. Sample
Collected
50050
.J00556
00530
00400
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
Total
Suspended
Solids
pH
mo/dd/ r
MG
inches
m
m
Units
New Motor Oil
Usage
al/mo
P+�
Forni S W U-246-1 12608
Page\ of x 1+

0 s
STORM EVENT CHARACTERISTICS:
Date
Total Event ecipitation (inches):
Event Duration ours): (only if applicable — see permit.)
(if more than one storNevent was sampled)
Date
Total Event Precipitation (r clres):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Atha: 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,
includi he possibility of fines and imprisonment for knowing violations."
(Sig t re of Permittee *te--
Forni
-/
S W U-246-1 12608
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