NCS000130 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 00o J ©'
FACILITY NAME &L lA C`� k A -1v\
PERSON COLLECTING SAMPLE(S) i 1 (\9—
CERTIFIED LABORATORY(S) Lab #
t Q l' i f••QC k T/1IC. Lab #165—
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: ao t
(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 R t I\D
PHONE NO. (!j I4)
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall 1•
Sample
Collected
.
1-1111371■No. Total
Rainfall
00556
�'li� MEO
No __�
v�
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SCT -HEM), if
appl.
16 0N' - M7®0
WMEW 0 12 A R., M
New Motor
Oil Usage
mo/dd/ r
MG
inches
m /I
m
unit
al/mo
ro 41 JnZA017//
1-5
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? V yes no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Reauirements
Outfall Date
No. Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SCT -HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m /I
m
unit
al/mo
ro 41 JnZA017//
1-5
Form SWU-247, last revised 2/2/2012
Page 1 of 2

r
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 3 (D - 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.)
FACILITYNAMEP,at p_ - ` %� �� �� _ COUNTY
PERSON COLLECTING SAMPLE(S) i l I t' 06 (` PHONE NO. Ci -- S13
CERTIFIED LABORATORY(S) Lab # - =
ef-j,`f `-Q-1NL:' .. Lab # .
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements.
..tet $ •� r �:'it'L� _
OutfalL - • f ;Date, =;x;
Sample Total
Collected
- _ �
50050
Flow if app.)
_ _ {,`ti .�
Total � -
Rainfall
-,t,_. -.•
�' AC_
('d IVl
_ - -- — - -o_._--.
FP �0- Tc�N
C 01,'U2
�` - _ -"-i1.
_-...r"-.r r•": �'. A:
G
inches'
Total
Oil &Grease
Non -polar
pH "
New Motor;°`''
ted'
(if applicable)
Rainfall
(if l.)
app
O&G/TPH' '
Suspended
p
-
6.09.
130
T, `•,, L_
`
(Method 1664
Solids
_ „'
ti,;,s7; ,.aL
_
N, h�' ; �.
'f(. :,-'.,F�}�c``;'.':_'� l� i�•1.t 1-�;4�'yC�
(„
ol•' i�lZ
`.
SGT-HE� if;°
M)
- -
.,t,•_ , 6
'•�LS� �'J'h...�i X`.a;d"
`;-Yx'w +"".
.,,.t 5'e`;o
mo/dd/ r.
MG'
inches
m /I -
m I ...
_ -
,
a
.unit :r
a1/mo
Does this facility perform Vehicle Maintenance Activities using more than'S5 gallons of new motor oil -per month? _V'yes _no
(if yes, complete Part B) J '
Part B: Vehicle Maintenance Activitv Manitarinu Rennirements
`Outfall : ; `, °". Date _
50050
00556
00530
00400
__..;
No`;3aE y-'' Sample .
Total Flow
Total
Oil &Grease
Non -polar
Total
pH "
New Motor;°`''
ted'
(if applicable)
Rainfall
(if l.)
app
O&G/TPH' '
Suspended
p
-
Oil Usage -:ws
,Collec
;r" y,,•;r: ;.
.:,t;,,Y �. •
T, `•,, L_
`
(Method 1664
Solids
_ „'
ti,;,s7; ,.aL
_
N, h�' ; �.
'f(. :,-'.,F�}�c``;'.':_'� l� i�•1.t 1-�;4�'yC�
(„
ol•' i�lZ
`.
SGT-HE� if;°
M)
- -
.,t,•_ , 6
'•�LS� �'J'h...�i X`.a;d"
`;-Yx'w +"".
.,,.t 5'e`;o
mo/dd/ r.
MG'
inches
m /I -
m I ...
_ -
,
a
.unit :r
a1/mo
Form SWU-247, last revised 2/2/2012
Page I of 2 -

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Date �.4
C3�S%? /n Ot < Division of Water Quality
Attn: Central Files ,
Total Event Precipitation (inches): 0• ©�j 1617 Mail Service Center
Event Duration (hours): O (only if applicable — see permit.) Raleigh, North Carolina 27699-1617
(if'more than one storm event was sampled)
Date
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."
(Signature of Permittee)
(Date)
Form SWU-247, last revised 2/2/2012
- Page 2 of 2