HomeMy WebLinkAboutNCG120053_MONITORING INFO_20170316r
GENERAL PERMIT NO.
CERTIFICATE OF COVI
FACILITY NAME t" /
PERSON COLLECTING SAP
CERTIFIED LABORATORY
Part A: Specific Monitoring Requirements
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
RECEIVED M
JUN 22 2015
CENTRAL FILES
DwR SECTION
SAMPLES COLLECTED DURING CALENDAR YEAR: ? �}
(This monitoring report is due at the Division no later than 30 days from the date
the facility receives the samplin fesf Jts from the laboratory.)
COUNTY G Avv u3
PHONE NO (704) —7 Y 2 - 20v --
PLEASE SIGN ON THE REVERSE 4
Outfall
'-No
':�� Date -•
$ample Collected
moldt
-' 00340ar ..: �
31616- s , µ s
S - -: 00530?- e,
Clietmcal O•xyg"en Demand,
'm L"�r s`Y -
'Fecal Co�4 orm� " 'w fps
# er 100•mis- s ' `'. �t
-' Total Saspeud ;SohdS t.
.... ; .'
100 =
2oc3
to
Note: If you report a sampled value in excess of the benchmarK value, you must impiememTic' i o• . •o, � .wp.,a— — •••..—
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 Activity onitorine Requirements
Outfall
No.
'- Date:.'
Sample Collected
= W556 i
_ 00530 "r
r 004tl0`a
' : Oil and Grease,
Total Suspended' Sohds,:New
MotWOd Usage, +_
Benchmark
_
30 '
100�-�
"3 6.0 .;;9:0.<; :•..,.:
r_<;�y t
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 t
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches):.
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
esponses.
Mail Original and one copy to:
Attn: DWQ Central Files
NCDENPJ DWQ
1617 Mail Service Center
Raleigh, NC 27699-1617
SWU-248-102107
Page I of 2
a
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
"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."
(Signature of Permittee) (Date)
S W U-248-102 107
Page 2 of 2