NCG060309_MONITORING INFO_20170203

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V 0 by a�
DOC TYPE
❑ HISTORICAL FILE
N MONITORING REPORTS
DOC DATE
9-0 1-�0at�
❑
YYYYM M DD

RECEIVED
FEB 4 3 20i7
CENTRAL FILES
©WR SECTION
I� p O�o I
STORMWATER DISCHARGE OUTFALL (SDO)
�y // MONITORING REPORT
Permit Number NCS NCC�jf� i 0000 SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report shall be received by the Division no later than 30 days from
J the date the facility receives the saa Gag results from the laboratory.)
FACILITY NAME d C S COUNTY C�w Ill
PERSON COLLECTING SAMPLE(S) a PHONE NO. (ICI!) 4
CERTIFIED LABORATORY(S) llr tatar.i a5 #
T^Lab
Ne- &L !•`Io SIGNATURE OF PERMITTEE OR DESIGNEE
�REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements WLU 3M-5-
F7'DIQ- :f Aft A[ q Oel
�r�
�
��
�
�
�
�
ter•
�■■■�■
�
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes
(if yes, complete Part B) 1]�
Part B: Vehicle Maintenance Activity Monitorinv Reauirements
Outran
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appi.)
Non -polar
O&GITPH
(Method 1664
SGT-HEM), if
appl-
Total
Suspended
Solids
pH
New Motor
Oil Usage
molddlyr
MG
inches
nwA
unit
Ilmo
Form SWU-247,Iasi revised 21212012
Page I of 2

STORM EVENT CHARACTERISTICS:
Date l i 30-ho
Total Event Precipitation (inches): a tO
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
Ann: 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 gatber and evaluate the information submitted. Sassed 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 tht possiWty of finSs and imprisonment for knowing violations."
O - 1 1
(Signature of Pe ttee (Date)
Form S WU-247, last revised 2/2/2012
Page 2 of 2

1 STORMWATER DISCHARGE OUTFALL (SDO
` MONITORING REPORT
Permit Number NCS SAMPLES COLLECTED DURING CALENDAR YEAR: 44 d�p
(This monitoring report shall be received by the Division no later than 30 days from
/� f the data the facility re/celivws the sampling results fram the laboratory.)
FACILITY NAME ITLI 1 COUNTY _
PERSON COLLECTING SAMPLE(S) r e. ✓ PHONE NO. T2_16_ Or
CERTIFIED LABORATORY(S) ab # /�l�TV
Lab# NG DW clrti' -
3 7#7 S-!r FSI�G�Ir'MNATURE OF PERMITTEE OR DESIGNEE
IR UED ON PAGE 2.
Part A: Specific Monitoring Requirements
f`P� �/V�oo9py
Outfall
DateNo. Sample
otal
P :'r 7,
r
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes Kno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total'
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GITPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/ddl r
MG
inches
m i
m
unit
atlmo
Form SWU-247, last revised 21212012
Pagel of 2

i
STORM EVENT CHARACTERISTICS:
Date r- ri -A-
Totaf Event Precipitation (inches): s �3
Event Duration (hours): 2! (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."
f �l�,t►�e �v � 17 ' l�G
(Signature of ermittee) (Date)
Form SWU-247, last revised 21212012
Page 2 of 2

w �- ( STORMWATER DISCHARGE OUTFALL (SDO)
PAC ,� 30
MONITORING REPORT
Permit Number NCS W SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report shall he received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
J � l
FACILITY NAME CE i ✓Y' ' COUNTY C6Z i OC4) bQ.
PERSON COLLECTING SAMPL (S)r r ,&- bellfojek, PHONE NO. ( ) F9 - 76 2
CERTIFIED LABORATORY(S)qjr_SV1jje
Lab # A1CpW C'.�r� �3'77§_S_
EQA�UCo0g0 REQUIRED ON PAGE 2. SIGNATURE OF PERMITTEE OR DESIGNEE
Part A: Specific Monitoring Requirements
Outfall
I
Date
1'TotalCollected
&1111141
if app.)
i I
#
_,_Bpw
F1711771 M.
I M.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yesno
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitorine Requirements
Outfall
No.
Date
Sample
Collected
50050
:
,00556.
00530
06460
Total Flow
(if applicable)
Total '"
Rainfall,`:
:Oil rease `
(ifappl.)
Non -polar
O&G/TPH
(Method 1664
' SGT-HEM), if
appl.
Tkal
Suspended
Solids
'H '
New Motor
Olt Usage
molddl r
. MG
inches
M
viign
unit
galvmo
Form SWU-247, last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): a St1
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
"1 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. 1 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-247, last revised 21212012
Page 2 of 2

RLZCE1 vE0
a1G 2014
CENr/,�,gL F
�WQ/QpG FS
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS C +O O SAMPLES COLLECTED DURING CALENDAR YEAR: t�✓��
/ (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 WVCU-kQ P1 aM COUNTY
PERSON COLLECTING SAMPLE(S) 40flhr, eff PHONE NO.
CERTIFIED LABORATORY(S) Labkl
t Lab #1 1 `t�
e—z> tj 03 %f 7fr SIGNATURE OF PERMITTEE OR DESIGNEE
1':'►t 1 T� REQUIRED ON PAGE 2.
Part A: Specific Monitoring Requirements E-04 W 067D C
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 R: Vehicle Maintenance Activity Monitorinv Requirements
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-HEM), if
appL
Total
Suspended
Solids
pH
New Motor
Op Usage
molddlyr
MG
inches
unit
mo
yar
Form SWU-247, last revised 21212012
Page l of 2

STORM EVENT CHARACTERISTICS:
Date Z i `( /
Total Event Precipitation 'aches): f i
Event Duration (hours): (only if applicablc— see permit.)
(if mare 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
tTalcigh, North Carolina 27699-i617
"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- 1 am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
<? Q 'a 4--,— 7—/ Y—/ 4L
(Signature of Pe ittee) (Date)
11 a� CTrnco.,e—
Form SWU-247, last revised 21212012
Page 2 of 2

yl e, (�-(o � d 3-0 y
RECEIVED ,4
DEC 07 ZU15 -
CENTRAL FILES
D1NR qPr-rlQN
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS / V e601" moo
FACILITY NAME r E � VZLA CC �i eia'e J�;Od j
PERSON COLLECTING SAMPLE(S) `[ 4,-c LAC!/.0 d/
CERTIFIED LABORATORY(S) _ e
p✓ ab #
,Ale Cyr * Lill,)
Part A: Specific Monitoring Requirements AR 0 W Ct f E if 3773-S
0--a
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling sampling results from the laboratory.)
COUNTY
PHONE NO.
SIGNATURE OF PERMITTEE OR DESIGNEE
REOUHiED ON PAGE 2.
1 I�®
.®
, ` WTOM TO®---
M"E
MF,_C�L«M00ff.
���Idl•1Sr*L�®��
����
Docs 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 Nionitorine Reuuirements
Outf&U
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&GITPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mold r
MG
inches
mrA
01211
unit
Ilmo
Form S WU-247, last revised 21212012
Page I oft

r
STO&M EVENT CHARACTERISTICS:
Date d - 2 d —f r Q�
Total Event Precipitation tnc es):
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_"
Is -
(Signature of Permittee) v (Date)
Form SWU-247, last revised 21212012
. Page 2 of 2

RECEIVED RECEIVED
MAY 11 2415 MAY 1 120 15
CENTRAL FILES ,_ ... ' r t= F_ ;=jLES
oWR SECiON -
NC6-06 o3by
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS Ala 6 6 0000 SAMPLES COLLECTED DURING CALENDAR YEAR:
(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 COUNTY
PERSON COLLECTING SAMPLE(S) PHONE NO. {J-�} 4L -
CERTIFIED LABORATORY(S) dL.b !14to
, Cetr 3 77 SIGNATURE OF PERM[lTTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Part A. SpeciOe Monitoring Requirements N tl
���larr,���wjr�■L�rr�or�,�ri�,�c��r�r�r�;rrr�l
��
��
�
i��
���
■■!:�■■■
��
Ala■
��■■�■
�lrl�'
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 B: Vehicle Maintenance Activity Monitorine Reauirements
Outfall
No.
Date
Sample
Collected
s005o
00556
00530
00400
Total Flow
(ifapplicable)
Total
Rainfall
Oil & Grease
(if appy
Non -polar
O&GITPH
(Method 1664
SGT-HEMS if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/ddlyr
MG
inches
m2A
metl
raft
Z.-I me
Form SWU-247, last revised 212/2012
Pagel oft

STORM EVENT CHARACTERISTICS:
Date
Total*nt Predpitatioa 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 applicablc — see permit)
Mail Original and one copy to:
Division of Water Quality
Arta: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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,
ineludins,the possibility of fuses and imprisonment for knowing violations."
U04-r-a
(Signature 761 elwore, (Date)
Form S WU-247, last revised 21212012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Resources General'Pe'rmit No. NCGO60000
Date submitted 11Z7LI9'
CERTIFICATE OF COVERAGE NO. NCG06�
FACILITY NAME _A> 6arre_ erne foals IVCCzO(�D30�'
COUNTY l'a to
PERSON COLLECTING SAMPLES SD �ber.H• _. __
LABORATORY 4yWom'Ife Lab Cert. if V0
)VOW ;0 9 77ss
FPA W NCoa9o9
Part A: Stormwater Benchmarks and Monitoring Results
RECEIVED
NOV 21 2010
_ DErNR-LAND QilALITY
SAMPLE COLLECTION YEAR Zit$ STORMW4iER PEi�M17TIiVr
FACILITY ACTIVITIES INCLUDE (check all that apply):
Nuse/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES �'NO
PLEASE ktM' El1AIBER TO SIGN ON THE REVERSE 4
Total event rainfall a 2. D3 or ❑ No discharge this period3
Outfall Na.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard.units
COD,
mg%L , ,
Oil and"Grea
mg/L :. ti I ~,
.Fecal Calif'ormy,
1colofi er 100„inl ,
Enterococcl n
,r,._ Colonies; er 100;,m1,.
Benchmark
-
iD0 or 50
Within 6.6 = 9.0 ..
_ 1120 .
:'" 30
,.• 10o0�""
o �t
. S
4t, Dr
' Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
CENTRAL FILES
DWR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ley no (if yes, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L ,
TSS; b
§.. -. mg%Lr: .,, ,
A'WH
.t ,Standard,units
New Motor Oil Usage,
Annualaayera�e gal/,mq,,
Benchmark
-
3D
`
Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012
Page 1 of• 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
0 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART.11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFA!_L? : YES ❑ NOP
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ . % ." ,i
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days'df receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
DiVision.of',Waker Resources_: �.�t j` +u ` b�� RECEIVED
Attn: DWR Central Files
1617 Mail Service Center NOV 21 2 IJ
Raleigh, NC 27699-1617
DENR-LAND QUALITY
STORMINATER PERMITTIPir-
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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."
0�-
(Signature of Permittee)
/(- ? —t,y
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr,org/web/`wq/ws/su/nodessw#tab-4
S W U-249
Last Revised: October 19, 2012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS e 6 0 � a() n SAMPLES COLLECTED DURING CALENDAR YEAR: v90
JVC(,,--b�6307
(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 C
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) 64-e",c; I lf-Ar,o.ly�lcerl
Lob #jUU&jd 37M—
CPA 0AttoOoq
Part A: Speclflc Monitoring Requirements
COUNTY
PHONE NO. -ECEIV
ED
SIGNATURE OF PERMITTEE OR DESIGNEE j N
REQUIRED ON PAGE 2.
h'AL FiL..
i'i5AlC c r..T. r
irau.. -
I
'
�7au
1 7 - _1
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) I
Part u: venicle
Mainten
lvity Itorinit Ke uirements
Ouffali
No.
Datc
Sample
Collected
15tl0S
Total Flaw
(if applicable)
Total
Rainfall
Oil 8c Gmusc
(If appl.)
Non p lar
Od�CFPH
(Method 1664
SGT-HEM), if
a I.
rOO5301KNIM
Tolnl
Suspended'
solids
(q0W ::
pH
:"
a
` _ N
lYcw 1Nntar ;
•11 Usage
DTI @ai a
Form SWU-247, last revised 21212012
Page I of 2

r-
STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): r� r
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm cvent was sampled)
Date
Taint 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 an 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 far knowing violations."
r.
.'�Kl
(Signature . f Pe ittee) (Date)
Form SWU-247, last revised 21212012
Page 2 of 2

I
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit NumberNC5 C 0(,, noO +Y�f
C��7
SAMPLES COLLECTED DURING CALENDAR YEAR: 120/7
(This i6onitoring report shall be received by the Division no later than 30 days from
F the date the facility receives the sampling results from the laboratory.)
ii �
FACILITYNAMB dV0. 0_e � i COUNTY 04G 6"'
PERSON COLLECTING SAMPLFA ) per PHONE NO. ((r94 ► A aa 4442-6
CERTIFIED LABORATORY(S) C J I Lab # NE Ct,4*.qyd
Lab # G W6*037796
EP)t AN60040i
Part A: Specific Monitoring Requirements
SIGNATURE OF PERMITTER OR DESIGNEE
REQUIRED ON PAGE 2.
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 B: Vehicle Mahntenance Activity Monitoring Requirements
CENTRAL_ FILES
DWR SECTION
OutfalI
Datek
Is0050�
C1N1S5b
100530
60tW00 ':.
t :.';
y r,-
No.
Sample
Total Flow
Total
mIG—rea—M
I Nonn p lac
Total
pH` #��
NewMotor•°° .
Collected _
(if applicable)
Rainfall
(if apply
(�GrTPH
Suspended
�r
Oil;lJsoc
SGT-HEM), If
w
""y
Imo/dd/"
IMG
lin'ches
!m AE
al/nir;T.
I
Form 5WU-247, Last revised 21212012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 0--/7
Total Event Precipitation inches): 3-
Event Duration (hours): a q hgS (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 property 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 gatheting the information, the Information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there arc significant penalties for submitting false Infarmallon,
Including the possibility of flues and Imprisonment for knowing violations."
�jd *-- d -love- ! 17
-
(Signature o Permittee) (Date)
Form SWU-247, last revised 21212012
Page 2 of 2

STORM EVENT CHARACTERISTICS:
Date a3-1-7 f q4
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."
TG�%/ 0,1,dre-
(Signature of Per ittee) (Date)
Form SWU-247, last revised 21212012
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
r Permit Number NCS_A(ed 0 � o coo _ P C %- c) 6 0 '307
FACILITYNAME Q
SAMPLES COLLECTED DURING CALENDAR YEAR: �?0/7
(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.)
PERSON COLLECTING SAMPLE(S) r
CERTIFIED.LABORATORY(S) -'k, r -y,�l� A,LiZ,Wi,-G ab #
Lab #
/Vt eerf 41NO E104 a 11r6 o 010?
rVa)k1 ecru-*3775_r
Part A: Specific Monitoring Requirements
COUNTY �C��Gtsv h
PHONE NO. JG 2C,
EREq
NATURE OF PERMITTEE OR DESIGNEE
IRED ON PAGE 2.
Outfail
No.
Date
Sample
11101111
ou
2 w1am
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 B: Vehicle Maintenance Activity Monitoring Requirements
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-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
Inches
mg/I,
m
unit
al/mo
Form SWU-247, last revised 21212012
Page 1 of 2