NCS000255 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS_000255 SAMPLES COLLECTED DURING CALENDAR YEAR: 2015
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the somplin"eu t t t oratory.)
IN
FACILITY NAME GREDE H COUNTY MONTGOMERY
PERSON COLLECTING SAMPLE(S) TIM MCCASKILL PHONE NO. (91 0)975-2W 0 4 2015
CERTIFIED LABORATORY(S) PACE Lab #_633
Lab #
SIGNATURE OF PERM OR ONGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
.ii
Date
-Sainple
I.:Collected
00556
00530
00400
-
Total Flow
Total -
OR & Grease
N6n-polar
Total
pH
New Motor
,Collected
(if applicable)
Rainfall
Ofappl.)
O&G/TPH
Suspended
Oil Usage,
(Method 1664
Solids
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X_no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorina Reaulrements
Outfall , ,-
Date
-Sainple
50050
00556
00530
00400
-
Total Flow
Total -
OR & Grease
N6n-polar
Total
pH
New Motor
,Collected
(if applicable)
Rainfall
Ofappl.)
O&G/TPH
Suspended
Oil Usage,
(Method 1664
Solids
SGT-HIEM), if,
a l."
r
mold r
MG
inches- ,
m
MgA
unit
gavino. -J
NA
NA
NA
NA
NA
NA
NA
NA
NA
Form SWU-247, last revised 2/2/2012
Pagel of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date _6/27/15 Attn: Central Files
Total Event Precipitation (inches): _0.5 in 1617 Mail Service Center
Event Duration (hours): _0.75_(only if applicable — see permit.) Raleigh, North Carolina 27699-1617
(if more than one storm event was sampled)
Date _NA
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 information,
Including the possibility of fines and imprisonment for knowing violations."
(/ -%/2t,/ Zoir�
(Signature of Permittee) (Date)
Richard Cabadas
Form SWU-247, last revised 2/2/2012
Page 2 of 2