NCS000369 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS r O 0 3(049 or
Certificate of Coverage Number: NCG
FACILITY NAME Fj4/C ?_-4A �er - k kr-r ed-- Cin PST•
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) TKf C- C -P-+ C2�1c Lab # Choj 33
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2`15-
(This
`1S(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
PHOM NO. (01 ED) Z-� -14
(SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
DateSample
Collected
II I
Total Total
Flow (if :pp
ii OR & Grease
00556
n_/
00400'
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/ r
MG
inches
m
Units
al/mo
_► k I :-
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes -V-40
(if yes, complete Part B)
Dart R. vahirla Maintananra Activity Mnnitnrinv Rennirementc
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400'
Total Flow
(if applicable)
Total Rainfall
Oil & Grease
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/ r
MG
inches
m
Units
al/mo
Form SWU-246-112608
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): 3
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 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."
AL21 U� 0-\Uce- (S
(Signature of Permittee) (Date)
Form SWU-246-112608
Page 2 of 2