NCG210034 DMR SW (2)

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
GENERAL PERMIT NO.NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: 49.0)(
CERTIFICATE OF COVERAGE NO.Nt iFI wt (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 j POLL UPI A er" C pct„ COUNTY0 n']��0!"r) e
PERSON COLLECTING S P ES al 9 e n _ I V D PHONE NO.( 9/0) _� 9 br'- 61))
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CERTIFIED LABORATORY - Lab# .6
Lab# JUN 1 6 a G i b PLEASE SIGN ON THE REVERSE
Part A:Specific Monitoring Requirements' CENTRAL FILES
DWR SECTION •
Outfall Date 00530 00400 00340
No. Sample Collected, Total Rainfall, Total Suspended Solids, pH, . Chemical Oxygen Demand(COD),
mo/dd/yr inches mg/L Standard units mg/L
Benchmark* - - 100 Within 6.0-9.0 _ 120
I ag-IR -J I ate , �1 E -
2
0...-7-12 -lb , .� 1 :2 _ 2 4 _
'Monitoring is required only if the facility stores exposed piles of sawdust,wood chips,bark,mulch,or other similar material on site for longer than seven(7)days.
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(Stonnwater 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 exposed(either exposed to incident precipitation or exposed to stormwater run on)piles of sawdust,wood chips,bark,mulch,or other similar material for
longer than seven(7)days on 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,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 run on)for longer than seven(7)
days before removal since filing the last discharge monitoring report."
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Name(Print name)
Title(Print title)
(Signature) (Date)
SWU-245-072808
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