HomeMy WebLinkAboutNCG210418 DMR SWSTORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number- NCS or
Certificate of Coverage Number: NCG
FACILITY NAME ---%Aub W (Y)•D PLoQld 6j�_,�AA
PERSON COLLECTING SAMPLE(S) /' Jf�(L6S/�7�jVer-
CERTIFIED LABORATORY(S) P. Iah #
L #B
2 g Zvi
Part A: Specific Monitoring Requirements
9NTRAI
0
SAMPLES COLLECTED DURING CALENDAR YEAR: Q J
(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.)
COUNTYPHON
�DcvAl�
(SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
Outfall D ate
No. Sample
Total o:
�RaiCollected :i:
,
00530
00400
No. Sample
Collected
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 -
Units
gallmo
1 9/ /S-
8
7
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 R! Vehicle Maintenance Activitv Manitarina Renniremenk
Outfall Date
50050
00556
00530
00400
No. Sample
Collected
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 -
Units
gallmo
1 9/ /S-
8
7
Form S W U-246-062310
Page 1 of 2
STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches):
Event Duration (hours): 3 Hrs (only if applicable — see perinit.)
(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) (Date)
Form SWU-246-062310
Page 2 of 2