NCG100112_MONITORING INFO_20141219

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑HISTORICAL FILE
C� MONITORING REPORTS
DOC DATE
o k 1 y IQ i q
YYYYMMDD

STORMWATER DISC- \RGE OUTFALL (SDO)
MONITOb—iG REPORT
GENERAL PERMIT NO. NCGl00000 i
CERTIFICATE OF COVERAGE NO. NCGI00 C Y
�y
FACILITY NAME
PERSON COLLECTING SAMPLES l 1
CERTIFIED LABORATORY Lab #
I"'i#
Specific Monitoring Requirements:
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days €rom
the date the facility receives the sampling results froqLthe laboratory.)
COUNTY Crj�Swe 0 (",od
PHONE NO. C3N) �S�S Qtf
PLEASE SIGN -ON THE REVERSE 4
Outfall .L3.+•;
Date �,
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lri *�00530 r�,
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e
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Note: If you report a sampled value in excess of the benchmark value; -or outside the benchmark range for pH, you must implement Tier I or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date 4117 1Y (first event sampled)
Total Event Precipitation (inches): ^� t+►�
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
RECEIVED
DEC 19 2014
CENTRAL FILES
DNlR SECTION
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWU-251-102107
Page I of 2

For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Facilities that incorporate a solvent management plan into the Stotmwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a 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 monitoring requirement for total toxic organics (TTO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent management plan
included in the Stormwater Pollution Prevention "
Name (Print name) ,
rtle (Pcr r
(Signature) (Date) T�
"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 poss' ' ity of fines and imprisonment for knowing violations."
(Signature of Permittee).
1I�LL-/6 ly
(Date)
S wU-251-102107
Page 2 of 2

STORMWATER DISC' \RGE OUTFALL (SDO)
MONITOI,iG REPORT
GENERAL PERMIT NO. NCG100000
CERTIFICATE OF COVERAGE NO. NCG10 0
FAULITY NAME
rRb
PERSON COLLECTING SAMPLES i
CERTIFIED LABORATORY rlNeriT{cam _ _ _ Lab #
Lab #
Specific Monitoring Requirements:
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 samp 'ng resul from the laboratory.)
COUNTY
PHONE NO.
PLEASE SIGN ON THE REVERSE 4
Oiitfall kr:
Date `� r,L
7�1 b itt1.o H. _ f�
;�t.:sti0053fl>>Ak.,3,_<..OQ400.�,r�.:
,. fi- �;J.�'..P: %4 ;� bEk _' J.'
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a .c:Total IoauciEth
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Benchmark:'-
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ow
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Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must impleinent Tier I or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total vent Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
RECEIVED
MAY 0 2 2014
CENTRAL FILES
DWQIBOG
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWU-251-102I07
Pagel of 2

I For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table 11 of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvenl
management plan shall include a list of the total -toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such.a 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 monitoring requirement for total toxic organics (TTO), I
certify that to the best of my Iatowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent management plan
included in the Stormwater Pollution Prevention Plan."
Name (Print name
000C,�
(Signature) (Date)
"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."
(Date)
S WU-251-102107
Page 2 of 2