NCS000084 DMR SW (2)

STORMWATER D -1 -CHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS OC60
FACILITY NAME
PERSON COLLECTING SAMPLE S) Q C� r rye
CERTIFIED LABORATORY(S) oco- Avg&, Hca Lab kD
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: t;XO V�
r7 is monitoring report shall be received by the Division no later than 30 days from
eLpejkt[Fa it ty receives the sampling results from the laboratory.)
JAN 2 a 2016 COUNTY WSec,- 4C\Vt0s 0"-
PHONE O. (�\ o ) , -1 b 3-- `
!90�b
CENTRAL FILES �
DWR SECTION (SIGNATURE OF PERMIT OR DESIGNEE)
By this signature, I certify tha this report is accurate
complete to the best of my knowledge.
Outfall Date
No. Sample
Collected
50050
Total
Flow (if app.)
Total
Rainfall
mo/dd/ r
MG
inches
00530
00400
6,20
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEl!/t% if
appl.
Total
Suspended
Solids
pH New Motor
Oil Usage
mo/dd/ r
MG
inches
_
m /t
m /l
unit gallmo
Does this facility perform Vehicle Maintenance Activities us111g moie than 55 gallons of new motor oil per months _yes �/no
(if yes, complete Part B)
Part R• Vohirin MnintPnnnrP Artivitv Mnnitnrinu Remrirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEl!/t% if
appl.
Total
Suspended
Solids
pH New Motor
Oil Usage
mo/dd/ r
MG
inches
_
m /t
m /l
unit gallmo
Form S WU-247-062310
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 17-1k-i01's
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."
(Signature of Permittee)
)/yakl 6
(Date)
Form S WU-247-062310
Page 2 of 2