NCS000452 DMR SW (4)

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STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT ^^''
Permit Number:NCSiOQ %
4 . or SAMPLES COLLECTED DURING CALENDAR YEAR:Q d .0
Certificate of Coverage Number:NCG (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.)
•
FACILITY NAME rzU&L4Qcc,X t 0 cQth%<ç1 UN Y R 141 1A
PERSON COLLECTING SAMPLES) Tl tMo'��,1 P Q h • 1�:
CERTIFIED LABORATORY(S)6 1,y Erl U 1 Lab a L HONE.14'A_ `/ j-�s_'' -i'
l Lab# ��I A URE OF P ' I'''T OR DESIGNEE)
By this .ignature,I certify that this report is accurate
Part A:Specific Monitoring Requirements co ple e to the best of my knowledge.
Outfall Date 50050
No. Sample Total Total COD Total ;it pH 1
Collected Flow(if app.) Rainfall Suspended L
Solids(TSS) eicI)b 5 C p4=021L.
mo/dd/yr MG inches mg/1 mg/1 mg/1 Units 1W /L
O I (5/511(2 .1 Oa') a < 10 < 1. 0 _< .�O -71.Z...0 _M
...EGEwo)
_ _ ,
okf "a .
CE r�►o -
DWR SEG
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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 B:Vehicle Maintenance Activity Monitoring Requirements 4--
Outfall Date 50050 00556 00530 00400
No. Sample Total Flow Total Rainfall Oil&Grease Total pH New Motor Oil
Collected (if applicable)
Suspended Usage
Solids
mo/dd/yr MG inches mg/1 mg/1 Units
gal/mo
Form SWU-246-1 I9fnu

STORM EVENT CHARACTERISTICS: Mail Original 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 .• '*ledge and belief, ',accurate,and complete. I am aware that there are significant penalties or submitting false information,
in ding t e possibility of fi ` .nd imprisonment for knowing violations."
/°'1°
(Sign• f Permittee) (Date
Form SWU-246-112608
Pn rr.1..9