NCG060358_DMR_20211005

STORMWATER DISCHARGE OUTFALL(SDO)
35 g MONITORING REPORT
Permit Number NCS N�hCIUOeino' SAMPLES COLLECTED DURING CALENDAR YEAR: 1X 1
ment of
(This monitoring report shall be received by the Division no i r han 30 days from
the date the facility receives the sampling results from the it� nta Quality
Kcy'/EC(1 I(I.b ,,, . I co( Received
FACILITY NAME 5 n COUNTS C
PERSON COLLECTING AMPLE(S) f2(�(kin Poo I PHONE NO.(7) ,) I j. /-()( OCT 0 5 2021
CERTIFIED LABORATORY(S) 010 rl fP('I1 1 I/1(>. Lab#
Lab# WlnstOn►Salem
SIGNATURE OF PERMITTEE OR DESIG giona Office
REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total Total PH ,r� p
Collected Flow(if app.) Rainfall �TS5 L OD 0 i`I (�sl62w
mo/dd/yr MG inches 1W PO— —C1 00 111 / 50 WO^
I 5-3-qI 1,0-1 if CDi1 ?S Z.
LI 5 2)- /.07 LO'� (y, 3 a?I �-�
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?Oyes iXno
(if yes,complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 _ 00530 00400
No. Sample Total Flow Total Oil&Grease Non-polar Total pH New Motor
Collected (if applicable) Rainfall (if appl.) O&G/TPH Suspended Oil Usage
(Method 1664 Solids
SGT-HEM),if
aPPI•
mo/dd/yr MG inches mg/I mg/1 unit gal/mo
i
Form SWU-247,last revised 6/12/2015
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Date j"�j I Attn: Central Files
Total Event Precipitation(inches): I i07 1617 Mail Service Center
Event Duration(hours): (only if applicable—see permit.) Raleigh,North Carolina 27699-1617
(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 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."
(Signature of Permittee) (Date)
Form SWU-247,last revised 6/12/2015
Page 2 of 2

STORMWATER DISCHARGE OUTFALL(SDO)
358 MONITORING REPORT ��11
Permit Number NCS NG-Gott) - SAMPLES COLLECTED DURING CALENDAR YEAR: ,90a0
(This monitoring report shall be received by the Division no later than 30 days from
LL ,� the date the facility receives the sampling results from the Ial�r'ato 41-tment of
FACILITY NAME Keq / E 0 GlU COUNTY at I I f occi. Enviro;irirental Quality
,, Received
PERSON COLLECTING SAMPLE(S) PHONE NO.(aj31Q) 951-a4D I
CERTIFIED LABORATORY(S) Me►'I ec 11 , l►'l 0—• Lab# Ut,1 0 5 2021
Lab# F
SIGNATURE OF PERMITTEE OR DESIGNwriston-Salem V
REQUIRED ON PAGE 2. Regiona office
Part A: Specific Monitoring Requirements
Outfall Date 50050
No. Sample Total Total //��
Collected Flow(if app.) Rainfall � SS V COD °1 Kee.
mo/dd/yr MG inches ((j9 019/1- Co-q 120 71/- 30i'1'1C9//-
I (1-lc - lt) I, i(G (.P. 1(2 L G ir,-
11-1a-a0 1i .4a.-7 7. 3 415 4:5
11-1a-a0 i, 40,(o L0,55 416- 49
1 11 -0-a0 I, Lf iro.qI a1 4�
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?Dyes pno
(if yes,complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No. Sample Total Flow Total Oil&Grease Non-polar Total pH New Motor
Collected (if applicable) Rainfall (if appl.) O&G/TPH Suspended Oil Usage
(Method 1664 Solids
SGT-HEM),if
appl.
mo/dd/yr MG inches mg/I mg/I unit gal/mo
Form SWU-247,last revised 6/12/2015
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Date (1'p-xO Attn: Central Files
c/
Total Event Precipitation (inches): I I g 1617 Mail Service Center
Event Duration (hours): (only if applicable-sec permit.) Raleigh,North Carolina 27699-1617
(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 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."
t11c � `�- ( o ? ,\�S ID
-- o
(Signature of Permittee) (Date)
Form SWU-247,last revised 6/12/2015
Page 2 of 2

STORMWATER DISCHARGE OUTFALL(SDO)
r 3511
5$ MONITORING REPORT
Permit Number NCS NC(�Ca((�( -- SAMPLES COLLECTED DURING CALENDAR YEAR: (
(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 la `'7 rtm'nt c`
I^ Lriv �. .._nt::i :. uali:y
FACILITY NAME Kay/Cc(. I C(b COUNTY 1L1( l r i ```"i`J"I
PERSON COLLECTING SAMPLE(S) KO(I/I Q.I Pa)I PHONE NO.(Viii^) / (-,244G'j
CERTIFIED LABORATORY(S) Mp I' tea)I tea) i nO . Lab# 1- 2i;21
' Lab# inston-Salem;
SIGNATURE OF PERMITTEE OR DESIGEE"W
REQUIRED ON PAGE 2. Regior al Office
Part A: Specific Monitoring Requirements `J
Outfall Date 50050
No. Sample Total Total
Collected Flow(if app.) Rainfall I 5 Pt I CO 0 U,)(/&1'eC6e-
mo/dd/yr MG inches IOOThC/L CO-CI O0 /G- 30t'1l O-
i C,Q-(p,-020F' Q.0t I q_ 1oi 5 a 4.5 u
l
y- ,.:)-(r)-,RJ X') 1 4 (0h1 4_ic G-S
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?Oyes 9 no
(if yes,complete Part B) ""
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No. Sample Total Flow Total Oil&Grease Non-polar Total pH New Motor
Collected (if applicable) Rainfall (if appl.) O&G/TPH Suspended Oil Usage
(Method 1664 Solids
SGT-HEM),if
appl.
mo/dd/yr MG inches mg/I mg/I unit gal/mo
Form SWU-247,last revised 6/12/2015
Page I of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Date .94: 0 1 Attn: Central Files
C
Total Event Precipitation(inches): q I 1617 Mail Service Center
Event Duration(hours): (only if applicable—see permit.) Raleigh,North Carolina 27699-1617
(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 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."
4 f�V
s% iLc�12�,1 � i D = - L l
(Signature of Permittee) (Date)
Form SWU-247,last revised 6/12/2015
Page 2 of 2