NCG120066 DMR SW (19)

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STORMWATER DISCHARGE OUTFALL(5D0) 1
MONITORING REPORT I '
Permit Number:NCS J ©s 0 or SAMPLES COLLECTED DURING CALENDAR YEAR: Del 2'0'2 IP .
Certificate of Coverage Number: N�CGapaawk M11 (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.)
FACILITY NAME )i keS CAA n cSo1 i0k COUNTY ri 11 be
PERSON COLLECTING SAMPL I 5) . i. .:L i• . P e I/NO. ..- A, d;6 "0 26/Y
CERTIFIED LABORATORY(S) /t - . Vi. �i Lab# ardi - - i 4,
Lab# (SIGN. TUItE OF PERMITTEE OR DESIGNEE)
, RECEI y this signature,I certify that this report is accurate
omplete to the est of my knowledge.
Part A: Specific Monitoring Requirements NOV 0 7 2016 '1
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Outfall ' Date' .( 50050' , , .,F;: .,. • ri"' �7' '•1 �• 'tl.u; ''-�, .fl.'.',I:bF• C'f.�. .•".-�?yl',P'i 1 r.'.''',,,'.•, • " .,
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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
(if yes,complete Part B) {
Part B: Vehicle Maintenance Activity Monitoring•Requirements
Outfall Date 'lir' 50050•' ' l II }. .f-14•?•): .1*t s_;"i;.. 'a-,}.,) " •i.;..:.:A,;(;tl •i;,,I.,:�,_: 00530�;3;1,�'.4.,''''',:: 004007.,;' 'J'i' (,
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Noy. , Sample' - Total Flow;' '1ti9tal:Raitu11ll v�,: 0 +8%'Greaiie.l-AS .Non-polar' ' -'0?T9tal '- }1'''.1„;� 'laH:; ,, ,i
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Form SWU-246-062310
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Mail i riginal and one copy to;
STORM EVENT CHARACTERISTICS: Divisi•n of Water Quality
�] Attn: i'entral Mlles
Dateo -,� ),Q�C � IV 0 i, iD\
1617 - ail.Service Center
Total Event Precipitation(inches): Raleig�,North Carolina 27b99-1617
Event Duration(hours): (only if applicable—see permit.)
(if more than one storm event was sampled) " •
,,, Date i
' Total Event Precipitation(inches): ,
Event Duration(hours): ' (only if applicable—see permit.)
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law,that this document and all attachments were prepared under my direction r.supervision in accordance with a
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"I certify,under penalty of the person
_ system designed to assure that qualified personnel properly gather mid evaluate the information submitted. Based on my inquiry
or persons who manage the system,or those persons directly responsible for gathering the information,the' 1 ormation submitted is,to the best
1 of my knowledge and belief,true,accurate,and complete. Iain aware that there are significant penalties f i r submitting false information,
Including the possibility of fines and imprisonment for knowing violations."
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fe4-&-141"--""---e; (S_4ature of Permittee) (Date) i
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,i it „ -246-062310
Form S WU
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