NCS000354 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NC_S0003.5 or
Certificate of Coverage Number: NCG
FACILITY NAME _ 5-7gRPF-T fin) c,
PERSON COLLECTING SAMPLES) Z2A jo N,IFr-r7An/
CERTIFIED LABORATORY(S) & c e lU 2 44 Lnh #—JL_
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Part A: Specific Monitoring Requirements
ORIGINAL
SAMPLES COLLECTED DURING CALENDAR YEAR: 2 ° 1.'
(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 RAN00,11-11
PHONE NO. (3)rd 1 6- TZ —6 I o 1 E,7 ; 3yj
(SIGNATURE OF PERMITTER OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
Outfall Date 50050
No. f Sample Total
Colimted Flow 730 O Co 17 S s ?" N S A S ; e'
moldtityr MG LL G L /YG L
( (03 i Q.5'S S3.z 3 CD. 00 0 SI O. 365
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes E'no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitm ine
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Form SWU-246-051100
Page 1 of ?

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NC S a as 3S 4( or
Certificate of Coverage Number: NCG
FACILITY NAME S T,0R PE 7" .tea 0
PERSON COLLECTING SAMPLES) 13RAo puFpry,gy
CERTIFIED LABORATORY(S) IvcA "R 7t_ Ii ab #_L_ __
ab # ' /4(
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total To 7 iia 4, 7o F,4 4
SAMPLES COLLECTED DURING CALENDAR YEAR: • O /-
(This monitoring report shall be received by the Division no later than 30 days from
the date the facWty receives the sampling results from the laboratory.)
COUNTY &Rnl glo j, e#
PHONE NO. (tel ! 72
O. ;
(SIGNATURE OF PEhM[i1TEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
7-6
u/W T r 7
Ad-ZL C_ C. s777. r/itrii-S
5. 60 C to n
Does this facility perform Vehicle Maintenance Activities using mora than 55 gallons of new motor oil per month? _Yea
(if yes, complete Part B)o
Part B: Vehicle Maintenance A vity M R meats
Ou" Bate adH05D. (�6
N6.SaMph
(Wearl Z�Otal8 motor
Goiteeted Grease Supendid
-0111,-Usage
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Form SWTJ-246-051100
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STORM EVENT CHARACTERISTICS:
Date 3 -3 —14 i
Total Event Precipitation (inches): a 3
Event Duration (hours): 5. S
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
Mall 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 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,,
3_1 D _ /
(Signature of Permittee) (Date)
Form SWU-2460111
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