NCS000456_MONITORING INFO_20171206

--STORM WATER-DIVISION-CODING-SNEET -- --
PERMIT NO.
NC-5 W)�G�
DOC TYPE
❑FINAL PERMIT
MONITORING INFO
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ 20 I'-1 1'2- 0(0
YYYYMMDD

s
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS or SAMPLES COLLECTED DURING CALENDAR YEAR k_�
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 e. JI OC �+u[SD'Q,�.Y 1�1 RPrIZ i��COUNTY VQ.1r1
PERSON COLLECTING SAMPLE(S) 1 % � NE NO.
CERTIFIED LABORATORY(S) x�1h Lab # ATURE OTr — - Lck-. RMITTEE OR DESIGNEE)
Lab # JA N 1 0 2018
jB rthis signature, I certify that this report is accurate
DW'�PI SECTIGN te to the best of my knowledge.
Part A: Specific Monitoring Requirements 'P"FORPAATId PROCESSING UN1T
1 Date WITIN11
Sam le, Total
P Total
Collected (if ip Suspended 0.,-
to OMNI===
Solids
—1
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes o
(if yes, complete Part B)
Part R! Vehicle Mnintennnep Artivity Manitnrinu RenuiremPnte
Outfall
No.-: _
Date
Samples
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total Rainfall
a
Oil & Grease.
Total
Suspended s
Solids`
pH,
New Motor Oil
Usage
molddlyr
MG,
inches
Units
allmo
Form SWU-246-112608
Page h ofl

STORMWATER DISCHARGE OUTFALL (SDO)
�,�,� MONITORING REPORT
Permit Number: NCS Cc 47t` s t or SAMPLES COLLECTED DURING CALENDAR YEAR: 01
Certificate of Coverage Number: NCG
_')CNL
FACILITY NAMEVA
PERSON COLLECTING SAMPLE(S) V 1
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Specific Monitoring Requirements
(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.)
COUNTY V
P E NO. -
A PERM E OR DESIGNEE)
B this signature, I certify that this report is accurate
mplete to the best of my knowledge.
IWITIMIIf
-
ended7
���
�;
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 Activitv Monitoring Reauirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total Rain
Oil & Grease
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/ddlyr
MG
inches
MRA
1 Units
al/mo
Form SWU-246-112608
Page2o3

STORM EVENT CHARACTERISTICS:
Date
Total Event eci tion (inches):
Event Dur 'o h u (only if applicable — see permit.)
(if more than a vent 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 In owledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
i udi g the possibility offinpes and imprisonment for knowing violations."
lure of Permittee) V (Dal
Form SWU-246-112608
Page` of3

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS O Q Q '+cc� I e
FACILITY NAME CCAVe- C li- Y \A 4& I` t46Q_J2U Ins
PERSON COLLECTING SAMPLE(S) M rtin _6YLAL,W1r1
CERTIFIED LABORATORY(S) Shealy Zr-) v &Qa- Lab #ZSDLI
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 290
(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.)
COUNTY C-QA L) r %
PHONE NO. (98 I l Q
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Date
Sample
-Collected
11 I
Total
Flow (if app-)�_
Total
'Rainfall
•
- -
-_
EMMU WIN!.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes � t no
(if yes, complete Part B)
Form SWU-247, last revised 2/2/2012
Page 1 of$ 3

M
Permit Number NCS (�> Q> C> JL5 L
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
FACILITY NAME _ CAVe C%_�j kNZ:�cQ Pr�,Q 0-)n
PERSON COLLECTING SAAIPLE(S) _n m YL�t�YI
CERTIFIED LABORATORY(S) ZVwAl�t Zn V &"Z- Lab # `�
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: AQ 0
(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.)
COUNTY C-2,A Uhl
PHONE NO. (&n E)
SIGNATURE OF PERNIITTEE OR DESIGNEE
REOUiRED ON PAGE 2.
Outfall
YSample
---]Collected
Date
'
NORM
BE M-1
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes \m no
(if yes, complete Part S)
Form SWU-247, last revised 21212012
Page"kofx 3
a

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/FPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/ddlyr
MG
inches
unit
al/mo
STORM EVENT CHARACTERISTICS:
Date
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
i "lion, including tl ekossibitity of fines and imprisonment for knowing violations."
S 1� 1?
(Date)
Form SWU-247, last revised 21212012
Page � of \
13 3

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS Q 0 ' c
FACILITY NAAIE Cs VQ- C'-� I Vim&
PERSON COLLECTING SAMPLE(S) -n V-� WYI
CERTIFIED LABORATORY(S) Z,—)v &Q2 Lab # ��_
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEARo( 1 �
(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.)
COUNTY C-Q%Uhl
PHONE NO. (2k5 E _Le 3
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Daterr
Sample
1 f
r
I
•
�,
i
�-
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)
RECEIVED
JAN I I zou
CENTRAL_ FILES
DWR SEC114N
Form SWU-247, last revised 21212012
Page l of3

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS Q C) 0 �± L
F.�CILI�'1' NAl•lE UJL'� C%-�� \-�C& 2�+zj 12U)rZ
PEIISON COLLECTING SAi1II'LE(S)
CEI2TIF11sfI [,AI30R:�TOKY(S} c5-%l,fir"!� � �y �� LaU # ��_
Lab #
Part :%: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: MCP
(This monitoring report shall be received by the Division no later than 30 clays from
the date the facility receives the sampling results from the laboratory.)
COUNTY C-Q-4 tJE i`-1
PHONE NO. (&5 ij U
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
f
,
OF Ak,
Divs iliis laci li(y perfivrm Velliele Maintenance Activities using more than 55 gallons ofnew motor oil per month?_ yes' , no
of yeti, coniplele. Part B)
Form S WU-247, hat revised 2/2/2012
Page,i,ofx 3
a

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
/l
me
unit
allmo
Ed
STORM EVENT CHARACTERISTICS:
Date
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 my, knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
in(--r—m-ati n, including the possi ' 'ty of fines and imprisonment for knowing violations."
(Sig fur of Permitt (D &)
7
Form SWU-247, last revised 21212012
Page � of$
3 3

STORMWATER DISCHARGE OUTFALL (SD ) 7:7,
MONITORING REPORT
Pernut Number NCS 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 WVE C►rt' VAN: &&
PERSON COLLECTING SAMPLE(S) Tt w�1CL�y��1 1
CERTIFIED LABORATORY(S) V SQ2 Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY C-2R L)'P— l
PHONE NO. Q�bfj U 3 1-
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Date
Sample
tt r
Does this facility pertbrin Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
(if yes. ecomplete Part B)
Yes -,no
HFCF[1/ED
APR 2 2 2016
DWR SECTION
INFORMATION PROCESSING UNIT
Forni SWU-247, lust revised 21212012
Page 1 ofx 3

J
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS -:-') �3 Lc
FACILITY NAI%I1✓ L U�� �-► : 't �7t k �±;� 3�t?1nC�
PERSON COLLECTING SAIIPLE(S) Tt x-V-,
Lab #
Part A: Specific Aloniloring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: aO I (e
(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.)
COUNTY
PHONE NO. (Qh Vic?
SIGNATURE OF PERMITTEE OR DESIGNEE I
REQUIRED ON PAGE 2. `
Date
Sample
Collected
'011511FM
Does this tacilily licrkiriu Vehicle Maintenance Activities using more than 55 gallons ofnew motor oil per month? _ yes �'�, no
Iit'vcs. Complete Part B)
Form SWIJ 247, lust revised?/2/'0I2
Page I.,ofX

...
n

A*
Part B: Vehicle Maintenance Ac ivity Monitoring Requirements
Outfall
No. -
�-
Date
Sample
Collected
50050
00556
00530
00400
Total now
(if applicable)
Total
Rainfall
OR & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), if
aPPI.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
unit
gallmo
STORM EVENT CHARACTERISTICS:
Date
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
infornta ' ,including the possi i 'ty of Gnes and imprisonment for knowing violations."
Z//7
--
(SignjdLVe of Pernuttee) ate)
Force SWU-247, last revised 21212012
Page 3of 3

17
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
'r �O
Permit Number NCS O O O 1-k- p SAMPLES COLLECTED DURING CALENDAR YEAR: �
(This monitoring report shall be received by the Division no later than 30 days from
n the date the facility receives the sampling results from the laboratory.)
FACILITY NAME CiZ)Ve C kjrj U)ZA _ r��U »>lS? COUNTY C-QA L) -�
PERSON COLLECTING SAMPLE(S) T1 vn� Y2AWY1 PHONE NO. La
CERTIFIED LABORATORY(S) c5V%ewL A1�i Zn V �Lab # (SE IVED
Lab #�$C� 07 201
SIGNATURE OF PERMITTEE OR DESIGNEE
EVT�� FILES
REQUIRED ON PAGE 2.
C�
Part A: Specific Monitoring Requirements ©NT St L F ION
t
Dateii
Sample
Collected
SM.
r
iM
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)
�1
r
CMD
0
-v
MOC
Form SWU-247, last revised 21212012
Page 1 ofx 3

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 0 Q Q J+ rS I
FACILITY NAME CA1Je. Ct*, � cQ P pQJ2ui�ST
PERSON COLLECTING SAMPLE(S) T1 Y-rt _6YLraWlrl
CERTIFIED LABORATORY(S) V-,,eAl� lLn V &.rz Lab #ZIS 'A!)
Lab #
Part A: Specific Monitoring Requirements
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.)
COUNTY C QA U"—I'l
PHONE NO. (Wu% Ei
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
1
Date
Sample
Collected
-
+ '
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
Form SWU-247, last revised 21212012
PageN,.ofx 3
a

Part B: Vehicle Maintenance Activity Monitoring Requirements
Outten
No.
Date
Sample
Collected
50050
00556
04530
00400
Total Flow
(if applicable)
Total
Rainfall
E
OR & 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
/l
n
unit
al/mo
STORM EVENT CHARACTERISTICS:
Date
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
t of my knowledge a belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
niorma 'on, including the sibility of fines and imprisonment for knowing violations." '11—.7 621vll" �
(�n>e of Perm ttee) (bade)
Form SWU-247, last revised 21212012
Page of\
,3 3

Permit lNuMber NCS 0(i-DQ) J+ cc� [-r
STORMWATER DISCHARGE OUTF ALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR:0%15
(Thus monitoring report shall be received by the Division no later than 31) days from
the date the facility receives the sampling residts from the laboratory.)
FACILITY NAME: Wuc—, COUNTY C-Q.A U4-r\
I'EI250N COI,I,ECTING SANIPLE(S) T1 r r, 'i� wn — PRONE NO. (Rn Ek lsz
CERTIFIEI) I,ABORA'CORI'(S) �1-zeAly 1Env &wz_ Lab # ` I
Lab # I KE
JUL 15 2015 SIGNATURE
REQjLRED ON PAGE IRMITTEE OR DESIGNEE
fart ,�: Specific Monitoring RequirementsCENTRAL FILE
2.
DWR SECTION
C7
0
�0
Dtws this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month'? — yes v no
(if've". complete fart 13.) —
Forni SWU-247, last rei-ised 21212012
Page I ofx 3

r: i:; ; N - - f ' '_ -. ?may �ea�,' `_.,,�,.. f.�„�,
w
L -
Asa:$. ..�.. _.
_..

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Veriftil NiiiliherNC`©Q
F,AClL1TV N:1i111: (�\)Q_ C►_���.��O�c� �2-4cpRYLU1>��
t'1;160N COLIAICTING SAANIPLE(5) Tlrn i3YZ�oWi'l
CI,W1'11� I l<',U L�1l3ClltATOKI'f S) �he�ly V L L:sb #
Lab #
11,111 A: 'Specific lionilorilig tle(Inirements
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report shall be received by the Division no later Ilian 30 clays from
the [late the facility receives the sampling results from the laboratory.)
COUNTY C Q-4 L) -.
PHONE NO. ) Le Th
SIGNATURE OF PoniffTEE OR DESIGNEE
REQUIRED ON PAGE
Oulfall
No.
i Dale
Sample
Cullecled
'
Q1-osp'V+ovus
arts-�rti►L
_rQ*__t
c1^rrior^'1rv+-►
l atak
Cs��P1�'��
mohldh.r
1), �cs III i. litcil ity ped6rill Vehicle N,I jintenance Activities Using more tlian 55 ,gallons of new motor oil per month? _ yes \4 no
01'vcs. compi tc part 11)
Farm SWU 247, lust rerised 4'?1_'012
a

7
r

Part B: Vehicle Maintenance ActiviA, Monitorin 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
p1I
New Motor
Oil Usage
moldd/vr
MG
inches
m /I
m /l
unit
al/mo
STORM EVENT Cl IARAcrERISTICS: 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 l�
Total Event Precipitation (inches): 6
`
Event Duration (hours): (only if applicable —see permit.) Q�.�
"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
tiou, including the ossibility of fines and imprisonment for knowing violations."
!7,
of Permittee)
(D te)
Form SWU-247, last re►•rsed 2121201?
Page � o fX
`3 3

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS Q (Q 0 J+ S L
FACILITY NAME CJZ)M C ti �� pak6q- 2 In
PERSON COLLECTING SAMPLE(S) `il i2AW�r1
CERTIFIED LABORATORY(S) �i1¢AZ_ �_ F-2VLQ,,rZ Lab # a L
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report shall be received by the Division no later than 30 From
the date the facility receives the sampling results from the laborsmu
COUNTY C QA ue l'1 C=
PHONE NO. (ice, A La 3 xt 0 C" 13
SIGNATURE OF PERMITTEE 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)
RECE1 V
au LZ�
GZ11014
C DW 8� FILES
G
Form SWU-247, last revised 21212012
Page 1 ofx 3

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 0 (0 O J-} ca� Ir 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 C OVe C1*1 k�& r Q4,wL�r_V
PERSON COLLECTING SAMPLE(S) "i,YLAWYI
CERTIFIED LABORATORY(S) ZN.Mly Friy — Lab #
Lab #
Part A: Specific Monitoring Requirements
COUNTY C.QA Ue-1i
PHONE NO. (2n
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
1
Date
SampleCollected
•
- - -
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)
Form SWU-247, last revised 21212012
Page'l,ofx 3
a

d
a
�'�
`.S
;1,
��
.`
::�y
,,,
,
�'
ww

' Part B: Vehicle Maintenance Ac ivity Monito ' e uirements
Outfali
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
pl.)
Non -polar
O&GITPH
(Method 1664
SGT-HEM), if
a
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/yr
MG
inches
unit
al/mo
STORM EVENT CHARACTERISTICS:
Date
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 lief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
info atr n, including the pos bility of fines and imprisonment for knowing violations."
b-, -h �'7 /
(Sig9d4e of Permittee) (Da
Form SWU-247, last revised 21212012
Page of\
'3 3 _ -J

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS QQ Q)
FACILITY NAME CA11e cli-1 kzcx��& pk*ZQJZ4u1ny
PERSON COLLECTING SAMPLE(S) T1+nr1Y2�pWr1
CERTIFIED LABORATORY(S) ;§1�1y
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: a01 �i
(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.)
COUNTY C-QA Ue"-'\
PHONE NO. (Rb g % 3 h
SIGNATURE OF PERMITTEE OR DESIGNEE
REED ON PAGE 2.
-DateCollected
Sample
II I
•
-m
W.
r�
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)
Form SWU-247, last revised 21212012
Page 1 of3

41

h,
v
Permit Number NCS OQQ> Jcc--7) Lr
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
FACILITY NAME _�?�JE �►�� ���a P2Ra�Q12U1r��
PERSON COLLECTING SAMPLES) Tl rn �YZAWr1
CERTIFIED LABORATORY(S)c5�rtiefily
Lab #
Part A: Specific Monitoring Requirements
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.)
COUNTY C.QA Uf-4'1
PHONE NO. (_Qn 61 La
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Date
Sample
Collected
Dcvs this facility pertorin Vehicle Maintenance Activities using more than 55 gallons ofnew motor oil per month?_ yes N4 no
(i f yes. complete Part B)
Form S WU-247, last revised 2/2/2012
PageNofX 3
a

Part B: Vehicle Maintenance Activitv Monitoring Requirements
Outfail
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
/l
unit
al/mo
STORM EVENT CHA.RACTERISTICS:
Date 6
Total en Precipitation (inches): o D3
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 t o my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
inf9f matio including the possibility of tines and imprisonment for knowing violations."
Permittee)
-� l
(Date)
Form SWU-247, last revised 21212012
Page onk
"2 '2

'77-

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Pcrmit Number NCS C)QQ JL5 LZ
FACILITY NAME CA1)e. C1*1 kzx d&
PERSON COLLECTING SA IPLE(S) -n v- - YZ pWr1
C[.KTIFIEU LA13ORATORY (S) S%wAly env 4a2 Lab #
Lab #
Part A: Specific Nioniloring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: wo F
(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.)
COUNTY C-QAUQ-1'l
ONE NO. (w% Sk Le
SIGNATURE OF PERMITTEE OR DESIGNEE
RE UIRED ON PAGE 2.
1Date
Sample
Collected -
a
— —
Docs this" facility perform Vchicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes \4no
(ifycs. compictc fart B
one
--�-� 7 r�
•3�1
Forin S WU-247. last revised 2/2/2012
PagAofX 3
a

m
�:
'
e:
�� ,
-
.k..
..

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 'j
SGT-HEM); if
appl.
Total
Suspended"
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m /l
mgA
unit
al/mo
STORM EVENT CHARACTERISTICS: lj
DatcUL-)14-
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
I617 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, including the possibility of fines and imprisonment for knowing violations."
1
(Dat
Form SWU-247, last revised 21212012
Page of,$
.3 3

7
,s
RECEIVE®
APR 0 S 2014
CENTRAL FILES
DWQ/BOG
April 1, 2014
Division of Water Quality
Surface Water Protection Section
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Stormwater Samnline Results, Permit No. NCS000514, Year Five- Period 2
To Whom it May Concern:
Attached are duplicate signed copies of the Stormwater Discharge Monitoring Results for Buckeye Mt. Holly,
LLC for Outfalis 1 and 2 as required by NPDES Permit No. NCS000514. The sampling event was conducted on
03/03/2014, with a total rainfali amount of .5 -inches as measured by an on -site rain gauge. All sampling results
were within the Benchmark Values for Analytical Monitoring as specified in NCS000514, Part II, Section B,
Table 3.
If you have any further questions, please feel free to contact me at 704-812-2023.
Attachments (2)
Sincerely,
Kristi Knight
Environmental, Health, & Safety Leader

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit No. NCS000514
FACILITY NAME: BUCKEYE MT_ HOLLY LLC
PERSON(5) COLLECTING SAMPLES: Earl Dinaess
CERTIFIED LABORATORY(5): SheabX Environmental Services, Inc. LAB 9 329
Part A. Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2014
(This monitoring report shalt be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY: Gaston
PHONE NO. [phone]
Date Sample
Total Flow (if
?�
3 '
Total`s:,
Susp idea
[hemi[al
Ox g n
Outfali Na.
Collected _
appllabl6Y:-.
' 4
Total Rainlali.
SoBds
Demands . ;r
pH
mm/dd/ -
MG'
iiiiliesz;`
rn ± ,_,
mg/#
std units.
t
001
3/3/2014
0.5
66
55
6.64
002
3/3/2014
0.5
81
92
6.5
BENCHMARK
> 0.10
1 100
120
6-9
Does this facility perform Vehicle Maintenance Activities using more than 55-gallons of new motor all per month? _ yes % no
Part B: Vehicle Maintenance Activity Monitoring Requirements (If applicable)
No.
Date Sam le
p
Collected
*
Tote)Ftow,(lft
applEcatiie .7 -Total
"
Rainfall
AAOutfal
Oi! and GO8G/TPH�.
Nonil po ar a t
_� _,
Suspended
Solids :
pH _
Moir d11�
..
Usages
�'
.
mni/dd/
MG �`
li"Ai'--:,'
— S �"�
mg/I s
trig/!-
std: units
gal/rizntli -
_
Signature of Permittee or Designee
I cwVfy, under penalty of low, that this document and all attachmanu were Prepared under mydlracdon or
supervision In accordance with a system designed to nrure that quol fled periamnal properly gather and evaluate
the information submitted. Based en the Inquiry of the parson or persons who manage the aptem, or these
persons directly responsible forgathering the Infomwtlnn, the information submitted Is. to the beat of my
edge and be4ef true, accurate, anti complete.I am aware that there are significant penalties for ssrbmitting
n7l
false information, Including the poriibUlty of rings and Imprisonment for knowbrg Aoladora
Mail Original and one copy to:
Division of water Quality
Attn: Central Files
1617 Mall Service Center
Raleigh, NC 27699-1617

ITT
a
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t

SHEALY ENVIRONMENTAL SERVICES, INC.
Report of Analysis
Buckeye Mount Holly, LLC
100 Buckeye Drive
Mount Holly, NC 28120
Attention: Eric Bolin
Project Name: Stormwater Discharge
Lot Number:PC03046
Date Completed:0311812014
C4 Lucas 0 rom �L_
Project Manager
Ace
� c
4� y
This report shall not be reproduced, except In Its entirety, without the written approval of Shealy Environmental Services, Inc, 1
The following non -paginated documents are considered part of this report: Chain of Custody Record and Sample Receipt Checklist.
4
Shaely Environmental Services, Inc. Page: 1 of 6
106 Vantage Point Drive west Columbla. SC 29172 (M) 701.9700 Fox (B03) 791-9111 www.sheat*b.com Level 1 Report v2,1
i

SHEALY ENVIRONMENTAL SERVICES, INC.
SC DHEC No: 32010 NELAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
Buckeye Mount Holly, LLC
Lot Number: PC03046
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary following this Case Narrative. The sample
receiving date Is documented in the header Information associated with each sample.
All results listed in this report relate only to the samples that are contained within this report
Sample receipt, sample analysis, and data review have been performed In accordance with the most current approved NELAC standards, the
Shealy Environmental Services, Inc. ("Shealy") quality Assurance Management Plan (QAMP), standard operating procedures (SOPs), and Shealy
policies. Any exceptions to the NELAC standards, the QAMP, SOPs or policies are qualified on the results page or discussed below.
If you have any questions regarding this report please contact the Shealy Project Manager listed on the cover page.
Shealy Environmental Services, Inc. Page: 2 of 6
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fox [phone] www.shealylab.com LOW 1 Repel v2,1

SHEALY ENVIRONMENTAL SERVICES, INC.
Sample Summary
Buckeye Mount Holly, LLC
Lot Number: PC03046
Sample Number Sample ID Matrix Date Sampled Date Received
001 STORMWATER #001 Aqueous 03/03/2014 0820 03/03/2014
002 STORMWATER #002 Aqueous 03/03/2014 0835 03/03/2014
(2 samples)
Shealy Environmental Services, Inc. page: 3 of 6
106 Ventage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.stsealylab.com Levet t Report v2.1

SHEALY ENVIRONMENTAL SERVICES, INC.
Executive Summary
Buckeye Mount Holly, LLC
Lot Number: PC03046
Sample Sample ID
Matrix
Parameter Method
Result Q
units
Page
001
STORMWATER #001
Aqueous
COD Slut 52200-
55
mg/L
5
001
STORMWATER OD01
Aqueous
TSS SM 2540D-
6t3
rng/L
5
002
STORMWATER #002
Aqueous
COD SM 5220D-
92
mg/L
6
002
STORMWATER #002
Aqueous
TSS SM 2540D-
81
mg/L
6
(4 detections)
Shealy Environmental Services. Inc. Page: 4 of 6
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com Level 1 Report v2.1

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Client: Buckeye Mount Holly. LLC Laboratory ID: PC03046-001
Description: STORM WATER #001 Matrix: Aqueous
Date Sampled.0310312014 0820
Date Recelved:0310312014
Inorganic non-metals
Run Prep Method
Analytical Method
Dilution Analysis Date Analyst Prep Date
Batch
1
(COD) SM 6220D-2011
1 03/18/2014 0845 AMM 1 03/17/2014 1630
1
(PH) SM 4500 H B-2011
1 03/05/2014 1030 AKW
41672
1
(TSS) SM 2540D-2011
1 03106/2014 1223 AMM1
41704
CAS Analytical
Parameter
Number Methed Result G
PQL
Units Run
COD
SM 5220D-20 55
10
mg1L 1
PH
SM 4500-H B 5.15
Su 1
TSS
SM 2540D-20 66
3.3
mg/L 1
PQL - PractIcal auantltation limit 8 - Detected In the method blank E - Ouantletion al Compound exceeded the calibralion range H - put of holding time
ND • Not detected at or above the PGL J - Estimated result < PQL and? MOL P • The RPD between two GC columns excoeds 40!, N = Recovery i3 out of criteria
Where applicable, an sail sample analysls are reported on a dry weight basin urdess flagged with ■ "W"
Shealy Environmental Services, Inc. Page: 5 01 a
108 Vantage Point Drtve West Columbia, SC 29172 [phone] Fax [phone] www.ehsalytab.com Level 1 Report v2.1

Client: Buckeye Mount Holly, LLC Laboratory ID: PC03046-002
Description: STORMWATER #002 Matrix: Aqueous
Date Sampled:0310312014 0835
Date Recolved:03103/2014
Inorganic non-metals
_
Run Prep Method
Analyticai Method
Dilution Analysis Data Analyst Prep Date
Batch
1
(COD) SM 522OD-2011
1 03/10/2014 0845 AMM1 0311712014 1630
1
(pH) SM 4500-H B-2011
1 D310512014 1033 AKW
41672
1
(TSS) SM 254OD-2011
1 D3/0612014 1223 AMM1
41704
CAS Analytical
Parameter
Number M21hod Result Q
POL
Units Run
COD
SM 5220D-20 92
10
m91L 1
PH
Slut 4500-H B 4.98
su 1
TSS
SM 254OD-20 81
3.3
mg1L 1
PQL - Practical quenhlatlon limit a = Detected In the method Clank E = QuenWatlen of compound exceeded the calibration range N - Out of holding time
NO - Not detected a% Dr above the PQL J = Estlmstad rwwll � PQL and � MDL P = The RPD between two GC columns exceeds 40% N a Recovery is out of criteria
Where app,icabla, all soil sample analysis are reported an a dry ws}ghl basis unless Ragged with a 'W-
Shealy Environmental Services, Inc. Page: 6 of 6
106 Vantage Point Drive West Columbia, SC 29172 (803) Mi-9700 Fax [phone] www.sheelylab.com Level 1 Report v2.1

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SHEALY ENVIRONMENTAL SERVICES1 INC.
Steal} �rvu�nrnal Sravie s, Ina. Parc 1 of I
fhrGLQ, �rllrnbr,. F•+1C1-01.6 f ICcr1ac�g trine OV24••11
Ea��4r
K�vijr�,�>Einea;t� �',,rt,Ir:
`�..`�. �..I
5amp�e Receipt Checklist (SRC.)
clicot' I i� }�_ i '�, --- Cnnles Iuspcctcd 11yf,4,rt: C r',3 Lot 4: , Lt L
Means ofreceipt, E �'SESI ❑ C5ent D UPS ❑ FedEx ❑ Airhnmi; Exp ❑ Other
yes `�o {�' - 1. WCTC custody 5"10 prcscmt on the cooler?
-
_
Yes No 2. If cusla scaiR were t rr�rat u era they intact and unbroken'
CnnIcr TD/Original
tcrnper'aMm upcm rcccipiVenved (corrected) temperanure upon rrccipt
f�4ctbod: ❑'f=perature
Rlarak Mottles IR Gun M:-k 3 Ifi oun Corsea'[iun Fac:lnrj 0,
Method of Coolant:
,EAainst
' lk'vt Tee Bluerce Dry Ice ❑ Krmc
If t spc�nsc is No
•
or Yes for 14. 1; ] !i , ut, ex lanatianhesci!utiun must he ra>7dofl. _
...•1-ff
�ctn cruture of any uoolerexceedied 6.0"C, was Pinject T4';mAggcrnotfftcd?
Yc ,)
Ycs )�u ❑
NA [,�- PM notified by SRC, phonc, mote (circle one), »thee.. (For
' coolm rCceived via (*riamtrcia) courier, PMs are to lie poi ,rich irnt ediatCly. _
\l1 ❑-' 1 4. Is the :mmrnmrial courier's pacicmg slip attached to this form? iI
S. C4'rrc pro er ets3tody proccdures� (relinquisbc+d'roceitied) Wowed?
KA 5awcrc ssrtlrl_ea rriirs bed by client to commercial Gnur7er't
6. Were S. le IDS lis'texl?
%. Was collection date & time 1 icicri7
8. Wr4,c tars lu be mforined listed ou the COC?
Did all samples arrive.. in Me per Wntainers for cash 1cst7
No
YesNo
n
No
NU
No
-
' Yc5
Yes
f -
Ya-,
tiv
Ycs
L
Yus3_q_'
:0. Did all crrntrfinrs label information (ID, date, time) d ine with rOC?
11. Did all containers ;arrive in ood condition uubrakcn, _Wb on, CW.)?
ttio
Yes
-NO .
12, Was F1 rani le. volume n�xilable=
13. Sucre all samples received a�•ithin a, the holding time or 48 hours, whicbrvta
yes
[ Nis ❑
Yes
No ❑
comes first?
-- 14, Wcrc aelv.sam 1m containers missing? --_
S, %Vcre there any excess sam less not listed on COC?
_
Yes
No
Yes A'oLJ1
Yes [� No U
16. VGere hobbles present = "Bess-;ica" (,'/."or 6m7n in diarnew) in any 1'DA
NA ©
%'fats?
1'Cs; - qb -
\A ; 17. Wcrc all metaIVO&G+HFM; tlurrierit Rrrn les irx ti rd at a x of <2
No
\A [Q' ! 18. Were all Cyanide andror su:iicle sempl ce rcivcd at a pH > 127 -
yak �... 19 Wcrr. salt applicable 1�113,'`I'Kl�+cyanide%phennl (•'t]3rnL,,J) smrrplCv firs 1f
Ycs No ❑
residual cblorinO
yes No
NA ❑' 20 Were Collection tempw'atttres tlocumLmLed on the CRC for NC sarnples7
Ycs n Q
NA -1. Wcrc client remarks/ tgucsts (i.e. requested dilutiunx, .N4% 1;T) desipn tiuns� j
'ern
_
etc..`) comctl • trtutserihed frtmn the COC into the comment sex inLIh4S. r
-
Sam le I'reaers•atio>re
P
lust be ctl lated fur, an • sam l 8 Eneorx
--rn. . n p r() Brdy prescn'tsd nr with headspacc-j
Salnplc(51 --
_ .. _
, u Crc rrc rivet] iu:tarrcz.tfd arescn cd and eve.*e adjusted
flccnrdin lj' in sainplc
reCe71 =Q .x•itll _II�;SO.,hNO3,HC1.. \ra0H) with the SR 9 (nu>stbcr)
Sample(•c} _ _ wcm received with bubbles >6 tram in
Samplc(s)-- - — -- _ ire rtw-imd urth TRC >0_2 mg
Sattivle labels v rifird y: na
Carreeive fiction take nececssav:
Was ulit:nl notified: Ycs 13 Na ID
SL'SI empicky-m _
Did client rt Rsnnd: ye; ! 1 No
I W c of response:_ -
Shealy Environmental Services, Inc.
106 Vantage Point Drive west Columbia, SC 29172 (803► 791-9700 Fax [phone] www.shealylab.corn Level 1 Report v2.1

r.
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS C)Q 0 J }- cc� L-r
FACILITY NAME Ch�Ve CA- \A oc& r`2Q,�jQ j�r1
PERSON COLLECTING SAMPLES) `il rn YLrgWn
CERTIFIED LABORATORY(S) 3\rti 1�I
Lab #
Part A: Specific Monitoring Requirements
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.)
COUNTY C.Q-A ue-r-1
PHONE NO. (9b S1 U
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Ou
if
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)
. mb t ��
_ Q_ -RI r�
Forni SWU 247, last revised 21212012
Page'i�ofX 3
a

4
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
'00530 1
00400-
Total Flow
(if applicable)
Total
Rainfall
Oil &-Grease :.Non
(if appl.) ;
-polar
O&G/TPH
.(Method`1664 °
SGT-HEM), if
-appl.
Total
Suspended
.Solids
!
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m 11. i
unit
al/mo
STORM EVENT CHARACTERISTICS:
Dateg- q.lw Q
Total Event Precipitation (inches): l
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."
" -,A,, - 4 C,- O my 3in /1
of Permittee) ate)
Form SWU-247, last revised 21212012
Page � otx
3 3

OF-1w
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS C(Z) 0
FACILITY NAME C�Ve- Cl-�l k�& PQuSIZ z wN
PERSON COLLEC,r1NG SAMPLE(S) TI r tiZ 3YLr�wn
CERTIFIED LABORATORY(S) 2;�heA__ l� Zy <,aa L Lab
Lab #
Part A: Specific Monitoring Requirements1
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.)
COUNTY C-QA Ue-Irl
PHONE NO. (&5 Sj La
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
1
1SampleRCollected
Date
_ r
i
T
1
Doer- this facility perform Vchicle Maintenance Activities using more than 55 gallons of new motor oil per month?'— yes �, no
(if yes, complete Part 13) Sa/rn, ' � ��Y� VJ2 Q)n)y C4k-�-+O
5C-�CA-A
Cop,
Form SAFLJ 247, last revised 21212012
Page,i\ofx 3
a

Part B: Vehicle Maintenance Activitv Monitorine Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530 i
00400 -
Total Flow
(if applicable)
Total'
Rainfall
Oil°&Grease
(ifappl.)
'Non -polar
O&&G/TPH
(Method 1664
SGT-H M), if
appLf
-Total. .1
Suspended
Solids
{
pH' -
New Motor
Oil Usage
mo/ddlvr
MG
inches
/l
man. }
unit
allmo
STORM EVENT CHARACTERISTICS:
Date
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."
(Date)
Form SWU-247, last revised 21212012
Page ofx
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