NCS000289 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITOR iG REPORT
Permit Number: NCS Oc�O A 7'? or SAMPLES COLLECTED DURING CALENDAR YEAR: _ _ —
Certificate of Coverage Number: NCG (This monitoring report shall be received by the Division no tater than 30 days from
the date the facility receives the samp[inrg results from the laboratory.)
FACILITY NAME S �t-^a"' w J �^C. COUNTY Q.i i '� L
PERSON COLLECTING SA.MPLE(S e a cJ r.�i� T P NE NO 6 – f
CERTIFIED LABORATORY(S) SC Lab # 37_5
Lab # (SIGNATURE O ERMIWEE OR DESIGNEE)
Part A: Spec Moni-foring Requirements
Att0A7i 4tr 5 ('LP4: r •s.. "�- t{'i 0.r vYi�;r L del �Ccr�;\�-rihf Yii
By this signature, I certify that this report is accurate
C_E_ complete to the
i•
`.
i� xis. +:
jk` �'^~' ,G�i 11j
L«r.--'y^�.
�'� f�.y'
;r 'l.s-�
�`� ���y_'Tr`•�i_�
.rIC.G.�'
'
_4 111
`tip' s•
r iy 37_.,y.,,--
a��:�
�' �i
:Y :1 ^ i
_
.�����i.;F���.-lL.r�t''�.'a
�''�+1t{"�—
- r =
1 iii'�E���`.{5�-"•�,Lf�S`����,':.S:C
•c f 2 C,
"7'T ;_�"F {' .� — r=:-��-�i'„TEi'�'
1 t �J�� i.' �•}1. '}'ta"-'.
'� �ree1 �¢`�„}'
.,ui�•�. �•.�F.Fir.”-�.
•e,�rF1.,��� .i.���+�C`���.^�j-
l � T ` �#'�
-��r�}�"' � w�
C>*s'iaC ,} _V - c' M.2 -
-w
r; • ��1.'.."�'%'` .r`'�K: _�17::�1,�':�c L'.'"'•' �4t���1.� a•+? a ,''i., .•'��^�"+ry
w'r'#y�t� (�i • y ►3+rl / r+iy�.v'tr'�, •���.�:-ir,"•.• =4 S. v
.p�.�c,��-r�.�s�pY'�,2�',�rl-��'•�:'r''a(r' a
.'�Pi•�,, d•�1. �j z:Fi ;cam, ��yrs; ��''� ����,��I`y.,:f Y�2y y�.1c:•'. ,��� i( �Ir
•1 �. '�� ��! ��y, ..�L.� ����!„4V�� 7 •t � i
`.iI3='h���/� ���_i._L`J Ihv•L•._Y:i�F'�'e e`'� fie?.:--l:La'.�.7 '���'Li5 .iT r. a1�s�'.rs�'S.Lt
� I' i. �7 -•w'. I. �'V T .'b !i�:� p �$ A.r
W}� �`t�'g}�+y1 t �! ���•..�T � /y V Y;
��w�hLYn�'�• •�.,/...•.iw���(dCY�.3'�w ;4 1ZV/71 �12C�..���1 .. '�1� L 1 ..�LlUktts`.
Yi'.
�'rf'�T
-i''.���FF,n 1
. (. :-�.��T
��y�. `
'�•
�� �1��.:
�,�,}�,l �" .'1F
r -•MS
(<V•rw'•;.
J
•.�••
^���L/.o..r _T_
a
. �.�'��.•....
Does this facility perform Vehicle Mairtrnance Acdvi�es using mora thw, 55 gallons of new motor- oil per Tionth? —yes keo
(if yes; complete Part B)

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see pernit.)
(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 docament 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 submit*ed. IIased on my ingairy of Lite person
or persons who orange 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 Eines and imprisonment for knowing violations."
( ignature of Pe e)
}