NCG120066 DMR SW (16)

STORMWATER DISCHARGE OUTFALL(SDO)
MONUOIiING REPORT I ,
Permit Number:NCS A-fes' ;t77b 611 a __ aTr SAMPLES COLLECTED DURING CALENDAR YEAR: 4 / --001
Certificate of Coverage Number: I CG t?IriTff (This monitoring report shall be received by the Division n -Fater ,i'an 30 days from
the date the facility receives the sampling-results from the laboratory.) '�•:
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FACILITY NAME \f J I k e CNA Y1 ado t id Wpsie.., - COUNTY 9 1 E',3
PERSON COLLECTING SAMPL + 5) . - h■ : JO' b �NO. - j - i, •!'• `"
CERTIFIED LADOItATORY(S) !« A Vlc2 WM= Lab# '�k ' G' 4� r
• Lab# 8 �` �� (SIGNATURE OF PERMITTEE OR DESIGNEE)
AUG 58 Z016 By this signature,I certify that this report is accurate
complete to the lest of my knowledge.
Part A: Specific Monitoring Requirements CENTRAL FILES
WR
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Outfall ' Date.' • 50050: ' . ' • ,:„7,...,....-,-;•,;:...,...-:,,,.;., .�:,i. ,,,...�i,a,��r.rr• '.a;;, .,�.t71,,;.z.•;•; a :�'<tr,;:,,!r''S ,,:;' :'t,R.$%`xyrYaaX;,itr:S,S •iy°.r.',,.` •
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No.` Sample` Tota ;; f 'r*"; `Ttal -. ,;�f,:rr v -I-g1�'.r.r.��.•r5.,„; ra.,}:r t15-?Y1,s ,-._.4 ''': 71l'r,ttb .$hl•.r.'i ;' g1.4"- ;.:''•- ''': ,J,r`^ . S, - , . .
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Collected I' •Flow,(llgpp.); lainfail ' ' I-`„-`•
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K,r 'rN` s' tt7• +t' �i '.',r.' }i ;',rN ",I;,Sl.�lirr-'�,,.1ucs r.r:Y:`7.1,1i•'t :r .-:I1''.•a. ^ckt" a I'4.''' I'.r,?,,[;..- r ; +•'tS1C;l.• r. L. , ' , , ,,. 5
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917-21)1(.0 !I ..
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Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes o 1
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(if yes,complete Part B)
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Part B: Vehicle Maintenance Activity Monitoring Requirements I
Outfall Date ,. 50050p..,,.:a ;r,,„ .00556-1,,^?,fir; .I. ,r.i•,.,.,:.;+ ....%-','.•-'-'• .00530,..-;
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:•r`,+<1.`� 00400
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No,: . Sample' ' ,. Totul Flow. f Tntai:Raihf-Rainfall of &Grea�ei Nun•polarr;,arZ9ta1>ya'tx ,ry,;. 'p ,,; ,`q>rr ; New
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Mo
tor Oil
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> 4 ,' J:r-.(:'R. ii. rr " tip.. t;4,„ lFtp.,.. . S ; de(l ,0, .myth+,''�' ,!'; YiCollected ' (f.applicabie)t:� :.."0\;',-,41,i.,.. ... °2 ', if appl•)34,},''17t 08tG ;, ;,,h , ,uspeuy,. , . ; . ,,;e•„ , . , ,, ,Usage • r'.
• ;e.' .✓•°,r r ,;7'.1-to0 _ r,, (ntlal66a,, Qag. 1 :V.!';';;',1;,•...;,,,..1,-,'•;.;;;.,1 ,1-.. .s I, •'I ' ,
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• , ' •.: S.:,, 4''-p' : ,t,•,i,'t,rf, r'ti,Pgis`'!r ! � {, F' } r:• .,!!,3.'.C•Sr'dp "I')v%�:a, , 1'•' , is i '`S •
r tFYIt, .•:2) y't''-' �r -al `.”-f''p:Y: i•Y.;', S +' 1Ip,r, • ,,, '',,,1t-;r' 5,- 4/`•h•.i,, ^tr ^3S •-'S•••P •5.� 1 ,
r c , . .•;:.;.f ' t.!'J • -,r:`�r.,I • .ti:,.xy4 ljL,.,.'?'i.l: r4µ . , ?�,Y'1rYri •%jY'r fP y,1.,*-4irvi- 1,2f'..` yJ' -Pa'-,,,r4 rr9: , ti ! 1 ..r
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:inc1es "`''i-';, ing/l . x'ii '.s „'• r„ ._ ;f�It4e' ;}.C r `� � 'r1 ,'r .h:,.. ' .; Utlt� t.i,I • �al�lO
Form SWU-246-062310
Page 1 of 2

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• Mall riginal and one copy to:
t' STORM EVENT CHARACTERISTICS: Divisi en of Water Quality
, : l�p _ t Attn: e entral Files
�` Date ��//��'' 1617 ail'ServicekCenter'
s, Total E entt P cipltation(Inches): RaleigNorth Carolina 27699-1617
��• � Event Duration(hours): (only if applicable—see permit.) ,I
(if more than one storm event was sampled)
i, t
: Date V
Total Event Precipitation(Inches):
Event Duration(hours): (only if applicable—see permit.)
i
in accordance with
'. "I certify,under penalty of law,that this document and all attachments were prepared Ali n msubmitted:'r Based on supervision
inquiry of the person
t system designed to assure that qualified personnel properly gather and evaluate the inf
or persons who manage the system,or those persons directly responsible for gathering the hiformatton,the: orination submitted is,to the best
1 ' of my knowledge and belief,true,accurate,and complete. I aim aware that there are significant penalties f u r sgbraltting false information,
including the possibility of fines and imprisonment for knowing violations." I
Oivt���.t./b,�r/.//��i� (Date)
it'
( ignature of Permittee)
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Forui SS
I-246-062310'; PageI-246-062310 2 of 2
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