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HomeMy WebLinkAboutNCS000134 DMR SW (12)STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Permit Number NCS 000 13 FACILITY NAME AVbCC` 1r L PERSON COLLECTING SAMPLE(S) , CERTIFIED LABORATORY(S) Enw,, v onyt\2vt+ --. Lab # Q_ Lab # Part A: Specific Monitoring Requirements SAMPLES COLLECTED DURING CALENDAR YEAR: 2.0 Is (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 %,e—A � e - PHONE NO. (ZSL '4'62.-2133 SIGNATURE OF PERMITTEE OR DESIGNEE REQUIRED ON PAGE 2. Outfall Date 50050 No. Sample Total Collected Flow if a mo/dd/ r MG 1 5 .O Total Rainfall inches !,'� Lq-a ci 1_ 1�,2Z 4S,�p..�(0 P%o5 horvS '1 SS C m9 l t" rng I L 031 �t94i 3 00556 00530 00400 Total Flow (if applicable) Total Rainfall Oil & 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 m /l m /l unit al/mo Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes VD (if yes, complete Part B) ID....L a. [To6inlo Mnin+nnonnn Aniivi4v 1VCnni1'nYina RPflI11YPTI1 P.IliS 1 k Outfall No. Date Sample Collected 50050 00556 00530 00400 Total Flow (if applicable) Total Rainfall Oil & 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 m /l m /l unit al/mo Form SWU-247, last revised 2/2/2012 Page 1 of 2 STORM EVENT CHARACTERISTICS: Date I1hos Total Event Precipitation inches): Z Event Duration (hours): . s (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." Cxlivv 12,11 1 I 1 S (Signature of Permittee) (Date) Form SWU-247, last revised 2/2/2012 Page 2 of 2