NCG210104 DMR SW (5)

STORMWATER DISCHARGE OUTFALL(SDO)
.-...e.v'r MONITORING REPORT
GENERAL PERMIT NO.NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: _
CE R TITS ICA'I E OF COVERAGE NO.N aGr2{l+ (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.)
FACILITY NAME___L-_ _____„__ n� /rs,� G� -
PfRSON COLLECTING sAMPIP, � e...- COUNTY CAGDCoac
PHONE NiT, I. e a/?-ys7 = t-1r,
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,,F.rt-t A:Specific Monitoring Requirements'
Outfall _v_I-. --- _._____-_----------1
--------_-._..__-___.____-1_�____-__00530w 00400 - -- _ __� 00340 _ - -- - AUG 1 9 2016
Date
No. ( Sample Collected, Total Rainfall, Total Suspended Solids, �___— __ _._ -__ .__ _
t mo/dd/;�r _ inches mpH, Chemical Oxygenmg Demand(COD), CENTRAL FILES
___.--_.__ g/I. Standard units
Benchmark* mg/1< D��
100 `Within 6.0•-4`0 _---_- ______ ___ �EC7 6t7n1
.. 120
--------------
S
r — --- — — -- — —� 1.4 — ,
Monrtonng is required only if the facility stores exposed piles of sawdust, wood chips, hark, mulch, or other similar material on site for longer than seven(7) days
if the facility elects nor 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(Stormwater 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 I or Tier 2 responses in the General Permit
racrlitres that do not stoic exposed (either exposed to incident precipitation or exposed to stormwater run on)piles of sawdust, wood chips,bark,mulch, or other similar material for
longi r than seven (7)days or,site may so certify,and the requirement for analytical monitoring may be 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,1 certify that to the best of my knowledge and belief,no piles of sawdust,wood chips bark,mulch or
other similar matenals were stored exposed (either to incident precipitation or to stormwater nrn On)for longer than seven(7)
days before removal since filing the last discharge monitoring report "
_
Namr (; not nr;, tri___,_._ ,__. _.., __- „,_ _m_,.__ -
rale(Print title ) - -
(Signature) (Date)
S WU-245-072808
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Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 00400 00556 00530
No. Sample Collected, Total Rainfall, New Motor Oil Usage, pH, Oil and Grease, Total Suspended Solids,
mo/dd/_yr inches Annual average gal/mo Standard units mg/L mg/L
Benchmark* �`— o — --�� 6.0–9.0 30 100
*Note. If you repott 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
Mail original and one copy to:
Division of Water Quality
Attn Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
()l \it'S1',tili;'\ Fills (.1.12l'll i('•\TION 1'()12 \\'1 1\l-ORM-V! ION Rl',POR CH) 1N PAI2I'S \ \VNl)/OR h:
"1 certify,under penalty on 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 rot knowing violation,.",
(Signature of Permit ec) (f)ate)
SWI i-%.15-072808
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