NCS000562 DMR SW (4)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000 %1 -
FACILITY NAME A(Ak Pt' c nv
PERSON COLLECTING SAMPLE(S) N
CERTIFIED LABORATORY(S) L -t - G(ta.lot k Lab # 53N L
Pac• I-Ab-AskvilIt
Part A: Specific Monitoring Requirements
RECEIVED
JUL 21 2014
CENTRAL FILES
DWQIBOG
SAMPLES COLLECTED DURING CALENDAR YEAR: U Qw.. ke)
(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 R� t4 <4o -.l
PHONE NO. (g2k_) 91 R - X13
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall Date
No.
Collected
W1111141
i
Flow (if app.)
i ._
Rainfall
i
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
122 AMM W
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 Xno
(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
appi.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m l
m l
unit
al/mo
Form SWU-247, last revised 2/2/2012
Page 1 of 2

STORM.EVENT CHARACTERISTICS:
Date C�
Total Event Precipitation (i hes): NI J'
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Ev nt Precipitation(itches):141
Event Duration (hours): NI lar (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 ssure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons wh nage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my w dge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including h po ibility of fines and imprisonment for knowing violations."
of
-?I4f1q
(Date)
Form SWU-247, last revised 2/2/2012
Page 2 of 2