NCG120088_MONITORING INFO_20180110

MN
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V CCU
DOC TYPE
❑HISTORICAL FILE
'�. MONITORING REPORTS
DOC DATE
° '01 I o
❑�S
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG120000 p SAMPLES COLLECTED DURING CALENDAR YEAR: 2.017
CERTIFICATE OF COVERAGE NO. NCG12_00 D $ (This monitoring report is due at the Division no later than 30 days from the date
�) the facility receives the sampling results rom the laboratory.)
FACILITY NAME L-O E' � V Y0410 M /D COUNTY
PERSON COLLECTING SAMPLES P Ct 4/1 GS _ PHONE NO. 7 Z'
CERTIFIED LABORATORY LabT�f`.�:
Lab # 1147D PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
JA N 0 2018
,.,.•_
Outfall
No.
Date
Sample Collected,
mo/dd/ r
00340 !„rj
r}gxR T, :'; °r(:31616
00530
Chemical Oxygen Demand,
"""yMid(Colifom r
# per 160 nil
Total Suspended Solids,
Benchmark
120
1000 colonies
100
z r W1
�.
z �-7
Note: If you report a sampled value in excess of the benchmark value, you must implement Tier 1 or Tier 2 responses. See General Permit text.
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 Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/ r
00556
00530
00400
Oil and Grease,
MWL
Total Suspended Solids,
W&
pH,
Standard units
New Motor Oil Usage,
Average annual al/mo
Benchmark
-
30
100
6.0 — 9.0
-
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 (first event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Attn: DWQ Central Files
NCDENR/ DWQ
1617 Mail Service Center
Raleigh, NC 27699-1617
S WU-248-102107
Page 1 of 2

STORMWATER DISCHARGE OtlTFALL (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)
Z-lo
(Date)
SWU-248-1021 o7
Page 2 of 2