NCG210104 DMR SW (4)

-
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT '. t.
GENIsRAL PERMIT NO. NCG210000SAMPLES COLLECTED DURING.CALENDAR YEAR:
,.-,_I:ER'ITFICATE OF COVERAGE NO. NCG21 /-.� d -
®�0� ` (This monitoring report is due at the Division no later than 30 days from'
the date the facility, receives the sampling results from the laboratory.) -
hACILITY NAME QROA�1 = LT..W •_..--.. _ _.:_ .. COUNTY C LL
PERSON COLLECTING SAMPLES _z
('Gt�' _' r � I'hIONI, NO. ) — ---�
'CERTIFIED LABORATORY , -PHONE-.. 3322
-- - -- __ —Lab #
_ __— .--- ------ --I,ah # --��-- I'LEASl• -
fart A: Specific Monitoring Requirem'e'nts'`. = „
Outfall
No.
Sample Collected,-
mo/dd//yr^
`Total Rainfall, -
inches
' 0040(f
00340'
_ _
Total Suspended Solids, pH, , - , '
:Chemical Oxygen Demand (COD),
Benchmark*
;`
�,a �'
mg/L
Standard units
—`-44
WTI?
100
Within 6.0 - 9.0
120
7 -
Monitoring is required only if the faci)ity stores exposed.piles of sawdust, wood chips, bark, mulch,-or;gther similar material on site for longer than seven (7) days -W."'
If the facility elects -not to monitor because accumulated -material is removed -within seven (7) days or less, the certification below must be signed. The facility shall .
also record and maintain a log in its SPPP (Stormwgler Pollution Prevention Plan) of dates when material is generated and removed, how, and by.whom.
'Note: If you report a value in excess of the benchmark value, or outside the benchmark range -(for pH), you must implement Tier 1 or Tier . -2 responses in the General. Permit.
Facilities that do not store expgsed (either exposed to incident precipitation or exposed to stonnwater run on) piles of sawdust, wood chips, bark, mulch, or other similar materia) for
longer, than seven (7) days on site may so certify, and the requirement for analytical monitoring maybe waived For those facilities that qualify for the analytical monitoring- waiver, the
discharger shall sign the following certification statement:
"based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
analytical monitoring, I certify that to the best of my knoWledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater nin on) for longer than seven (7)
days before removal since filing the last discharge monitoring report." '
Name (Print namc)�_—..__..__._-•---
Tide (Print title)
(Signature) .
ware
Rei''�D
CENTRAL i:;; Eq
CWR
S W U-245-072808
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C

r'c ` DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES,USING MORE THAN 55,GALLONS Of NEW MOTOR OIL PER MONTI ,' ON' \
AVERAGE, IN,THE CALENDAR YEAR?
❑ Yes ,[ No (If,yes;completePart. B). r'•
Part B: -Vehicle Maintenance Aciivity-Monitoring Requirements
Outfall Date'
No. Sample Collected,,
mo/dd/yr.
Benchmark*
- ,' :.'. - :'00400.
Total Rainfall; New Motor'Oil Usage, pH,
inches, . Annual average gal/mo Standard units
6.0-9.0
00556 '
Oil' and Grease,
mgtU '
- 30 ,.
00530 ..
Total Suspended Solids,
ntg1L _
100 '
*Note: If you report a value in excess of the benchmark value, or outside'the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the General Permit.
Mail original and one copy to:
-Division -of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
1'Ot 1 till iST SIGN nus CERTIFIC TION FOR ANY INFORMATION REPORTED IN P.1RTS A ANWOR-B:
"I certify, under penalty oaf 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 Wormation 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 fqr knowing violation's."
(Signa ure o - Permittee) (Dat /'
t } _ SWT 1-245-072808
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