NCG120066 DMR SW (7)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS l7 120o0o or SAMPLES COLLECTED DURING CAL-ENDAlr YEAR:COMM
Certificate of Coverage Numbers a _ �1 - (This monitoring report shalflie receivedy�tiic`�Divisi� `a� )ae' khan 30 bays from
the date the facility receives the shmpling results from the laboratory.)
FACILITY NAME V v > >k(fCOGn� % C,501;01
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) f0.C.e-nQ % seQ Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY � ` 9 ES
PHONE xo.
(SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
iSample
Collected
1 -■ '.
Totalr! -
Flow (if :pp
50050
00556
00530
00400
Total Flow
(if applicable)
Total Rainfall
OR & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT -HEM), if
appl.
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/ r
MG
inches
Units
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 Activitv Monitorine Reauirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total Rainfall
OR & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT -HEM), if
appl.
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/ r
MG
inches
Units
al/mo
Form SWU-246-062310
Page 1 of 2

}c' ngRM EVENT CHAACTE I TICS:
'Date laor y .Zen/k
Total Event Precipitation (inches):
Event Duration (hours): (o*l 'If 7pplicable — see permit.)
t o •,t '
(if more than ong sta;rm event M At s npimc C, S
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copyo� ,
Division of Vb' to ,Q,A jQ? YJ 1)
Attn: C#jW Ijle5
1617 Mail Service Cenfer
a , Ralei h, North Caro` a 276994617
C
"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.'Or,sgb�utting false information, -r �• , .
including the possibility of fines and imprisonment for knowing violations."
(Si nature of Permittee (Date)
Form SWU-246-062310
Page 2 of 2