NCS000289 DMR SW (17)

' STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
Permit Number: N� `- -_ or _ SAMPLES COLLECTED DURING CALENDAR YEAR:_ •
Certificate of Coverage Number:NCG - (This monitoring report shall be received by the Division no later than 30 days from
the date the facility receires the sampling results from the laboratory-)
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FACILITY NAME S IN t-no •dr .�1 Wa�D� r� tier,1 C. COUNTY A.cri 'moi,
PERSON COLLECTING SAMPLE(S Tar n1. . Oa- P Lab# r NO.( • ,. — 1-i i.ci
CERFil'_1'IED LABORATORY(S)
Lab# E 1 ' s ' (SIGNATURE OF PE• $ , EOR DESIGNEE)
•
APR 1 LI:
FILES2016 By signature,I certify that this report is accurate
complete to the best of my knowledge.
Part A: Specific Moniforing Requirements CENTRA
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Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? yes 4_no
(if yes,complete Part B)
Part B: Vehicle MaintenanceAct_ivi.Monitorin• Requirements
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Form SW-U-246-112608

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STORM EVENT CHARACTERISTICS: Mail-Or-iginai-and-one copy to: —
• Division of Water Quality
Date • Attn: Central Files
Total Event Precipitation(inches): 1617 Mail Service Center
Event Duration(hours): (only if applicable-see permit.) Raleigh,North Carolina 27699-1617
•
(if more than one storm event was sampled)
Date
Total Event Precipitation(inches):
Event Duration(hours): (only if applicable-see permit.)
•
"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 Eines and imprisonment for knowing violations."
4(1"CP1'
( ignature of Permittee) ��-
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Form SWU 246-112608