NCG060022 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NC G D C b 0 0 0 or
Certificate of Coverage Number: NCG O & OD A 2 -
FACILITY
FACILITY NAME
PERSON COLLECTINGAMPLE(S)
CERTIFIED LABORATORY(S) aM Lavb #�
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: ;?O/,S—
(This
?O/,S—(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
PHONE NO. o �fL ' -Z z -
(SIGNATURE OF P&WULTX&E A DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
Outfall DateNo. Sample
Collected
I I I I I • r ! 11 •
�i
i .
i .. �.
00530
00400
Total Flow Oil and
Grease
Total
Suspended
Solids
pH New Motor
Oil Usage
mo/dd/ r
MG m
m
unit al/mo
bl 1-7-3-1,4r
M -4e -L
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 Activity Monitoring Requirements
Outfall Date
No. Sample
Collected
50050 00556
00530
00400
Total Flow Oil and
Grease
Total
Suspended
Solids
pH New Motor
Oil Usage
mo/dd/ r
MG m
m
unit al/mo
bl 1-7-3-1,4r
M -4e -L
Form SWU-246-051100
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date1-23 ly
Total Event Precipitation (inches): • 9
Event Duration (hours): 4,92—
(if
„92
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
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 knowledgeand belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including thegelio of fines and imprisonment for knowing violations.”
z`. ez - 5
(Date)
Form SWU-246-051100
Page 2 of 2