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HomeMy WebLinkAboutNCG120066 DMR SW (14)STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Permit Number: NCS AfCG ) ad _ or Certificate of Coverage Number: NCiT �M FACILITY NAME �" PERSON COLLECTING SAMPL S) CERTIFIED LABORATORY(S) lrbrg Ark -Lab # Q Lab # Part A: Specific Monitoring Requirements SAMPLES COLLECTED DURING CALENDAR YEAR: - Gr/JZ. IZO J% (This monitoring report shall be received by the Division no ter than 30 days from the date the facility receives the sampling results from the laboratory.) COUNTY / PHONE N.O. (SIGNATURE OF PERMITTEE OR DESIGNEE) By this signature, I certify that this report is accurate complete to the best of my knowledge. Outfall -Date No. �i'Sample Collected Total Flow (if :.pp 'Total Rainfall 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 M94 M94 Units al/mo 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 i%- Vehicle Maintenance Artivitv Mnnitnrinu Renniremenk Outfall Date No. Sample Collected $0050 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 M94 M94 Units al/mo Form SWU-246-062310 Page 1 of 2 STORM EVENT CHARACTERISTICS: Date ZD I Total 10ent 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"kfes 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