NCG120066 DMR SW (11)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Perini( Number: NCS AICG 12 I)C),p 0 - or
Certificate of Coverage' N-miii-ber: NCG D 6 IQ
FACILITY NAME .;1ke_5, Nun'44 ZOW U
PERSON COLLECTING SAMPLY4s)k�2R![ 6Tnyd 4i)
CERTIrilElDL"OltATORY(S)-Mc-',:� AndQI.N-PtLab#__ TO
I Lab # I -
Part A: Specific Monitoring Requirements
I
SAMPLES COLLECTED DURING CALENDAR YEAR: 2DI5
(Tills monitor eport shall be received by the Division no later than 30 days from
,twea
6 receives the sampling-reAults from the laboratory.)
V
COUNTY
P , 0.
-6E1,jR.PLF1LS ') E ' ,
OWV� SEG'T10)F1GaNAA1TUM C401PPERMME OR DESIGNEE)'
By this signature, I certify that this report is accurate
complete to the 'Iesi of my luiowledge.
Outfall
No.---'
Mte.,
Sample,
Collected
50050,
IC' ow,(If Opp.)
f 1
x"I'v .4 'n
VW4 �M, x,1 r
%
., ef..
N, P:;n,
j,". , � �
- .
-
11101dd/yr
No,: Sainple.­."
Total
T?tal'Rihifql.1
Von-polor.",
tal"
-:New,Motor.OU
Collected
(If.applicab)Or,:
jlm .1 W
0&0.40
�y -
t)
Taw II
zzla�
air
v ae
j, .:
,
Dill., -1
moldd/yr
MG
Inches ",-o"
; T
4�0
—,
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? — yes
(if yes, complete Part B)
Part R! Whirlp. MnliAmimirp. Activity Mimitarinu RP.fm1rP.mmAq
- - -
Outfall Dptd_­______--_50050
e
____ k.j7--.
00556 _�111'i-y-, "';
j,". , � �
- .
-
No,: Sainple.­."
Total
T?tal'Rihifql.1
Von-polor.",
tal"
-:New,Motor.OU
Collected
(If.applicab)Or,:
jlm .1 W
0&0.40
�y -
air
v ae
j, .:
,
Dill., -1
moldd/yr
MG
Inches ",-o"
; T
4�0
—,
Form SWU-246-0623 IQ
Page 1 of 2

STORM EVENT :• CHARACTERISTICS:
rf 1� ? Date
y
Total Event Precipitation (inches):
T..o.,+ n..roHnn (hmircl! (only if analicaUle —see permit.)
! (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 r supervision in accordance with a
gather and evaluate the information submitted. Based on my inquiry or the person
FS� system designed to assure that quaked personnel properly g
` 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 ain aware that there are significant penalties f r submitting false Information,
e
Including the possibility of fines and imprisonment for knowing viola ons."
Mail Original and one copy to:
Divisic n of Water Quality
Attn: Central Viles
1617 D laU Service Center
Raleie i. North Carolina 27699-1617
Forni SWU-246-062310
Page 2 of 2