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NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit, httli-:Iliortal.ncdeiir.org/web/wq/ws/su/npdessw#tab-4
Permit No.: N/�/_/_/_/�/_/ /_/ or Certificate of Cover g No.:
Facility Name: f' Tu-.' ✓ �ct1 1 ; cr�wJ r� b
County: Phone No. �s8" 7✓' ZZ
Inspector: rY
Date of Inspection: Z
Time of Inspection:
Total Event Precipitation (inches): �^
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Eq /Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By this signature, I certify that this report i"ccurate and complete to the best of my knowledge:
(Signatur'b,�f PermV/ee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Descriptiio 1
Outfall No. #/ �SI �E tructure (pi e, ditch, etc.
Receiving Stream: �
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors
weak chlorine odor, etc.): "o
the discharge may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 (j�> 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes 6
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Lastmodiried 10/25/2012