NCG160102_MONITORING INFO_20140505

STORMWATER DIVISION CODING SHEET
NCG PERMITS
-----------------
PERMIT NO.
�V C� I W 1 D p�
[DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ I
YYYYM M D D

STORMWATER DISCHARGE OUTFALL (SDO) RiE &'V ED
GENERAL PERMIT NO. NCG160000 0 5 204
DISCHARGE MONITORING REPORT (DMR) cew
CERTIFICATE OF COVERAGE NO. NCG1600 00�
FACILITY NAME Hea--Tpo/Lt� 51-Te
PERSON COLLECTING SAMPLES J t� W l w t N 5
CERTIFIED LABORATORY 14wV#4 sme, -r t , 1N�Lab # to
Lab #
Monitoring Requirements
R
��A��
/L F�IE�
SAMPLES COLLECTED DURING CALENDAR YLpQ �o I
(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.) I" COUNTY e2Q U 1 M A j S
PHONENO. ZSZ-
zo�r-al
Outfall
No.
Date
Sample Collected,
mo/dd/ r
Total Rainfall,
inches
00530
00400
00556
Total Suspended Solids, mg4
pH,
Standard units
Total Petroleum Hydrocarbons, mg/1
EPA Method 1664 (SGT-HEM)
Benchmark
l00
Within 6.0 - 9.0
15
4-
' If a value is in excess of the benchmark, or outside the benchmark range (for pff), you must implement the 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
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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."
41 z1114-
(Date)
SWU-252-051409
Page I of 1

P.O. BOX 7085, 114 OAKMONT DRIVE
GREENVILLE, N.C. 27835-7085
ROSE BROTHERS (ELIZABETH CITY)
W. REID CLARKE
P.O. BOX 806
AHOSKIE ,NC 27910
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/1
TPH (1664A), mg/1
Stornnvater Analysis Method
(#I, Grab) Date Analyst Code
7.5 04/09/14 TRB 4500HB-00
<2.6 04/10/14 CMC 2540D-97
<5.0 04/16/14 SEJ EPA1664B
Drinking Water ID: 37715�
Wastewater ID: 10
PHONE [phone]
rAX [phone]
ID#: 491
DATE COLLECTED: 04/08/14
DATE REPORTED : 04/16/14
REVIEWED BY:j
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