NCS000538 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO)
i MONITORING REPORT Q
Permit Number NCS 07 0 S72 L? SAMPLES COLLECTED DURING CALENDAR YEAR:
(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.)
FACILITY NAME (-�Ieef`CC '/ZCOUNTY
PERSON COLLECTING SAMPLE(S) PHONE NO.8( Ig) 4 3/ • .l`•4—
CERTIFIED LABORATORY(S) LLaMg— An. l ED
La
NOV 16 W5
Part A: Specific Monitoring Requirements rFN-YRAL FILES
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Date
Sample
Collected
I I I rifii� _
i
19 V -3m Rainfall
------ --- .-..-..
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & 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
m /l
-unit
al/mo
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes too
(if yes, complete Part B)
.a T. X1_6_..1.. ISA •. dam. L......--- A -4-0 +ri BAnni1'nv D—iiiramonfe
rail D: V effiCIE 1Vlalu l.cll�lu�.c —
Outfall Date
No. Sample
Collected
—.. .•ay... ....
50050
------ --- .-..-..
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & 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
m /l
-unit
al/mo
Forret SWU-247, last revised 2/2/2012
Page l of 2

STORM EVENT CHARACTERISTICS:
Date 0 MIs"
Total Event Precipitation (inches):—
Event Duration (hours): (only if applicable - see pennit.)
(if more than one stone event was sampled)
Date -60-&1
Total Event Precipitation (inches)
Event Duration (hours):
� rle "'
(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, acid complete. I am aware that there are significant pe salt :;s for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
If
(Signature of Permittee) (Date)
Form SWU-247, last revised 2/2/2012
Page 2 of 2