NCS000374 DMR SW (2)

STORMWATER DISCH,.AGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS C�) OO_11rj 4
FACILITY NAME LLC
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) M i `irm b gr-- Lab # X
Lab #
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
Total
Flow if a
Total
Rainfall
TSS
Non -polar
O&G/TPH
(Method 1664
SGT -HEM), if
a 1.
mo/dd/ r
MG
inches
Y1r� L
Z
B
O.a I CT20
I•`t
30. o
inches
Q S
0. L
I - If
�o
S
8(. I 15-
o o 7 t
,
(Q.4�
(.
8 Ib'
O.bLi-
B
8 (.
O.114
'x,4. .3
SAMPLES COLLECTED DURING CALENDAR YEAR: 2 015
(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 'P c --6s5 Zz,N
PHONE NO. (cl It.)) rnr) – 3231
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? —yes
(if yes, complete Part B) —
Part B: Vehirle Main+Pnan— Anf:.,:f_ ]WA . �_-:_-
Outfall
No.
Date
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 /I
m /l
unit
al/mo
Form SWU-247, last revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date $- to -1 S
Total Event Precipitation (inches):, y'
Event Duration (hours): 3.1; (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 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."
1 �,- - I
1 MS I
(Signature of Permittee)
9//.?//5-
(Date)
Form S W U-247, last revised 2/2/2012
Page 2 of 2