HomeMy WebLinkAboutNCS000369 DMR SW (3)STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS (OO oS619 or
Certificate of Coverage Number: NCG
FACILITY NAME PW(– LPI 10arnel- Ge,
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) PVJC. CIEWS c 2E'!'k Lab # -0133
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: ZOI
(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 0-0 M SEA1 N�
PHONE NO. '9 10 -ZZ3 - 4 01 2
(SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
Date
1Sample
Collected
Total1
Flow app.)
I
Oil & Grease Tota,1 + 1
1 1 1 1
i
Solids
00556
00530 00400
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
Total pH
Suspended
Solids
New Motor Oil
Usage
mo/ddlyr
MG
inches
InVA
m Units
al/mo
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes Vno
(if yes, complete Part B)
ID- 4. n. v1e X4—tanonrn Aotivity Mnnitnrina RPnnirementc
Outfall
No.
Date
Sample
Collected
50050
00556
00530 00400
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
Total pH
Suspended
Solids
New Motor Oil
Usage
mo/ddlyr
MG
inches
InVA
m Units
al/mo
Form SWU-246-112608
Page 1 of 2
STORM EVENT CHARACTERISTICS:
Date 1 2 ';--
Total Even Precipitation (inches):
Event Duration (hours): (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 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."
N\��lZ I % ZO(S
(Signature of Permittee) (Date)
nW _
Form SWU-246-112608
Page 2 of 2