NCS000456 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 0 Q O L+ cc� Lp_
FACILITY NAME CAVe. Ct*y V0oocQ PQAZJMuin
SAMPLES COLLECTED DURING CALENDAR YEAR: 01\(3
(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.)
PERSON COLLECTING SAMPLE(S) T1 rv-i 6Y2At.J1r1 " C 3 C:nn
CERTIFIED LABORATORY(S) 3V-.e-A14£rn V &wz- Lab # C E I V E D
Lab # 6CT 0 7 2015
Part A: Specific Monitoring Requirements
CENTRAL FILES
DWR SECTION
COUNTY CQA 0e -
PHONE NO. (an bi LQ
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Date
Sample
Collected
Total
Flow (if ap
Total
Rainfall
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes o
(if yes, complete Part B)
Form SWU-247, last revised 2/2/2012
Page 1 of$ 3

V_
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS -(i::) (D O J+ cc� Ly
FACILITY NAME CSZ)Ve C'*1
PERSON COLLECTING SAMPLE(S) '1'1 ren t�YLpt,yY>
CERTIFIED LABORATORY(S) 3VwAly Zn v &Q.rL Lab # 3 �9
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: QUI �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 CQA Ue—Y N
PHONE NO. (2n
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
1
Date,
Sample
Coll d
.•
•
- + '
_�__
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes \v no
(if yes, complete Part B)
Form SWU-247, lust revised 2/2/2012
PageNk.of$ 3
a

Part B: Vehicle Maintenance Activitv Monitoring Reauirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
OR & 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
mg/1
unit
al/mo
STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches):
Event Duration (hours): (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
t of my knowledge anh belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
'
nforma on, including thessibility of fines and imprisonment for knowing violations."
Pe
Form SWU-247, last revised 21212012
Page ofx
3 3