NCS000452 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCSDOZ LL9 or-�
SAMPLES COLLECTED DURING CALENDAR YEAR: S
Certificate of Coverage Number: NCG 0
(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 tAni.,lc` 'c.+ (� �ltn� COUNTY
PERSON COLLECTING SAMPLE S) �T'l inno P NE NO.
CERTIFIEDLABORATORY(S) La RECEIVE)
Lab # S ATURE O FERMI' TEE OR DESIGNEE)
DEC 0 3 2015 B his signature, I certify that this report is accurate
Part A: Specific Monitoring Requirements CENTRAS FILES complete to the best of my knowledge.
Outfall Date 50050
No. Sample Total Total COD 707�
sad H
Collected Flow (if app.) Rainfall p �L,
�5 C.� PAZ
mo/dd/ r MG inches m Units
1 1 c, -) 1. C1 _ 1' 1
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes�no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitnrina
Outfall
Date
50050
00556
00530
No.
Sample
Total Flow
Total Rainfall
Oil & Grease
Total
Collected
(if applicable)
Suspended
mo/dd/ r
MG
inches
Solids
In
m
4--
00400
pH New Motor Oil
Usage
Form S W U-246-112608
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STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches):
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."
(Si atur of Permittee) (D e)
Form SWU-246-112608
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