NCS000130 DMR SW (5)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS Q Q 0 130
FACILITY NAME Pe—(' Lk -9—
PERSON COLLECTING SAMPLE(S) 1 •4..
CERTIFIED LABORATORY(S) Lab #
MQr Lab# (�
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: ! rs
(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 %" C. k pp O (i cQ
PHONE NO. (1 l D) 3
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall DateII
1. Sample
Collected
I
Total1
Flow
• '
r
00530
00400
Total Flow
Total
Oil & Grease
Non -polar
Total
pH
New Motor
No. Sample
WNW
(if applicable)
Rainfall
(if appl.)
O&G/TPH
Suspended
Oil Usage
(Method 1664
Solids
SGT -HEM), if
appl.
mo/dd/ r
MG
inches
m /I
(.
m /l
unit
al/mo
16 DCS Ifj
Pt
las.261
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? r yes _no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date
50050
00556
00530
00400
Total Flow
Total
Oil & Grease
Non -polar
Total
pH
New Motor
No. Sample
Collected
(if applicable)
Rainfall
(if appl.)
O&G/TPH
Suspended
Oil Usage
(Method 1664
Solids
SGT -HEM), if
appl.
mo/dd/ r
MG
inches
m /I
(.
m /l
unit
al/mo
16 DCS Ifj
Pt
las.261
Form S WU-247, last revised 2/2/2012
Page 1 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS ooQ 130
FACILITY NAME 6 Zckltojv`/V%
PERSON COLLECTING SAMPLE(S) W ► l G0( e—
CERTIFIED LABORATORY(S) Lab #
Mlen I 2 Lab #—
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: ,2�5
(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
PHONE NO. ( n) R
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall DateII
No. Sample
Collected
I
Total
Total
Rainfall
00556
i
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 /I
m /l
unit
gallmo
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 Activity Monitoring Requirements
Outfall Date
No. Sample
Collected
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 /I
m /l
unit
gallmo
Form SWU-247, last revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): 25
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."
(Signature of Permittee)
1111611
(Date
Form SWU-247, last revised 2/2/2012
Page 2 of 2