NCS000208 DMR SW (2)

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Permit Number NCS CYV —'20 R'
STORM WATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: 12015
(This monitoring report shall be received by the Division no later than 30 days from
p the date the facility receives the sampling results from the laboratory.)
FACILITY NAME CCP � ) /-t ��®
PERSON COLLECTING SAMPLE(S) ,-6
CERTIFIED LABORATORY(S) Etiurr�('he fn Lab # B 02 2015
Lab #
CENTRAL FILES
Part A: Specific Monitoring Requirements DWR*SECTION
COUNTY r cF
PH N NO.
(SIGNATURE OF OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
U913 ia-uny pernonn venicte maintenance Activities using more than 55 gallons of new motor oil per months
(if yes, complete Part B) yes s no
Part B: Vehicle Maintenance Ac ivity Monitorin Requirements
Outfall Date
No. Sample
Collected
50050
Total Flow
(if applicable)
Total
Rainfall
00556
Oil &Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT -HEM), if
a 1.
00530
Total
Suspended
Solids
00400
pH
New Motor
Oil Usage
g
mo/dd/ r
MG
inches
m
m
unit
al/mo
Form SWU-247-062310
Page 1 of 2

STORM EN ENT, CHARACTERISTICS: - Mail Oi igitial=and one copy'to:
'Division of-Water Quality,
:. Date- _
Attn: Central File's
Total Event Precipitation (inches): �• �y - 161-7 Mail Service Center Y
Event Duration (hours): (only if applicable —see pernut.) - -" -
Raleigh, Nortt► Carolina 27699-1617
(if more than one storm event was sampled)
Date- -- , . • - - .. .- .. -. _ -� - - - -• � _ _ _ _
Total,EJent Precipitation (inches):
Event Duration'-( I hour (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-ii
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 tbe_possibility, of lines-and imprisonment for knowing violations." -
(Signa re ermittee) = (Date) -
Form SWU-247-062310
Page 2 of 2