NCS000222 DMR SW (4)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS
Certificate of Coverage Number: NCG or SAMPLES COLLECTED DURING CALENDAR YEAR 01 S
(This monitoring report shall be received by the Division no later than 30 days from
l l� e the date the facility receives the
FACILITY NAME sampling results from the laboratory.)
1 y��
PERSON COLLECTING SAMPLES LA COUNTY�Qu�l
CERTIFIED LABORATORY(S) S U Lab #� PHONE NO. 8 l O)
Lab#CEIVED
Part A: Specific Monitoring Requirements
OCT 0 7 2015
CENTRAL FILES
(SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ ye
(if yes, complete Part B)
Part B: Vehicle Maintenance Activit Monitorin Re uirements
Outfall Date 50050
No. Sample Total Flow Total Rainfall Oil & Grease Total 005 6 004
Collected (if applicable) Suspended
pH
ended
sS"-no
New Motor
Usage
Form S W U-2 16-1 1 2608
Pao- 1 nf'V14

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS or
Certificate of Coverage Number: NCG
FACILITY NAME COe` Z2 A rlGL l L
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
No. Sample Total Total
Collected Flow (if app.) Rainfall
MG
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�EU n
PHONE NO,
(SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
ng/lnr. _ , 3 4_ ia�k ;`�cen,Q
lq
4 1
Does this facility perform 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 Activit Mottitorin Re uirements
Outfall Date 50050 00556
No. Sample Total Flow To 00530 00400
Collected all Oil &Grease Total pH New M�otorl
(if applicable) Suspended
Usage
Form S W U-246-1 1 2608
Pnoa116n09 11

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS 11)1&& or
Certificate of Coverage Number: NCG
FACILITY NAME
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
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 t
PHONE NO. (per
(SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
'© LZ
�' Q+se. P TK �'l lOx 111
° m m
.� lit8 T� ft L ir. •, 1
Does this facility perform 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 Activit Monitorin Requirements
Outfall Date 50050 00556
No. Sample Total Flow otal Rainfall Oil & Grease Total 030- 0400
Collected (if applicable) pH Suspended New Motor Oil
mo/d r MG innhnc �_n
Solids Usage
P44
units
Form SW U-246-112608
Paee\ of N 11

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches):
Event Duration (hours): PP
(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
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
system designed to assure that qualified personnel Properly
or s who manage the s s p p Y gather and evaluate the information submitted. Based on my inquiry accordance
p on
g Y or those persons directly responsible for gathering the information, the information submitted is, to the best
my kn wledge and belief, tr accurate, and complete. I am aware that there are significant penalties for submitting false '
Including the possibility of f s nd imprisonment for knowing violations."
g e information,
of Permittee)
*(ODate)#�
Form S W U-246-112608
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