NCG060309 DMR SW (3)

RECEIVED
FEB 0 3 2017
CENTRAL FILES
DWR SECTION
IlI J 6--o (p o 3o C/ STORMWATER DISCHARGE OUTFALL(SDO)
A, L MONITORING REPORT
/Y
Permit Number NCS Ce0000 SAMPLES COLLECTED DURING CALENDAR YEAR: , t.-//
(This monitoring report shall be received by the Division no later than 30 days from
/n� (' I the date the facility receives the sa pling results from the laboratory.)
It
FACILITY NAME Civamee pt ere- lac)QS COUNTY Cala LU, &
PERSON COLLECTING SAMPLE(S) 'Tclh„ Abe rvlairky PHONE NO. ) -'7( 27
CERTIFIED LABORATORY(S) 91-4too19nrd yiLs4,1 ILab#
Lab#
NC ce.4. L idr SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A:Specific Monitoring Requirements NOW l U 1t??5-c
Ef'r g RCC ac Oct.
Outfall Date 50050 f _
No. Sample Total Total e,!a'i'oil;Cllr�t o; A SS c
Collected Flow(if app.) Rainfall bKy�,'tt nes&GY,1 t �'' I J J
mo/dd/yr MG inches J
A7 Cq.G
dZ AO /fau
Flati
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month9_yes no
(if yes,complete Part B)
Part B:Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 50050 00556 00530 00400
No. Sample Total Flow Total Oil&Grease Non-polar Total pH New Motor
Collected (if applicable) Rainfall (if appl.) O&G/TPH Suspended Oil Usage
(Method 1664 Solids
SGT-HEM),if
appl.
mo/dd/yr MG inches mg/1 mg/1 unit gaUmo
Form SWU-247,last revised 2/2/2012
Page 1 of 2

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
/1 '��3 Division of Water Quality
Date Atm Central Files
//
Total Event Precipitation(inches): S(0 3 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 th possi lity of fin s and imprisonment for knowing violations."
,0 a /- . -/--1
(Signature of Pe ittee (Date)
Form SWU-247,last revised 2/2/2012
Page 2 of 2