NCS000541 DMR SW (4)

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
Permit Number NCS 000 5 41 • SAMPLES COLLECTED DURING CALENDAR YEAR: 201
(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 SoukAzrn Slates IA \ ( .er�;I izer COUNTY Ro\ipeo n
PERSON COLLECTING SAMPLE(S) o rarla �,hson • PHONE NO.( cl ID ) X y 3- 4`-15 b
CERTIFIED LABORATORY(S) 5 SC 04, Cr 110✓�OA Lab# IJG Di g 13
Lab# (SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature,I certify that this report is accurate
complete to the best of my knowledge.
Part A:Specific Monitoring Requirements .
Outfall Date 50050
No. Sample Total Total 7-01-0-( i TS S s-u l£a I
Collected Flow(if app.) Rainfall Phos porut s - I
13Qr\cbvmw-k mo/dd/yr MG inches "9. mi5 /L ICO rr19J L oo al f L (r,-ci 5,_O,
c1 al` L ) I 3.-7 o,as 6-1_J (0, 6 (. 01
•
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 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/TPHr • ,Suspended '• .'• Oil Usage
- (Method 1664' Solids
GT-HEM),if • -
appl. ' :.3;
mo/dd/yr MG A cher / mg/1 • • unit ;_ • •, • gal/mo
/ .
Form SWU-247-062310
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