NCS000130_DMR_20210818

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG120000 SAMPLES COLLECTED DUI ING CALENDAR YEAR' c�j�
CERTIFICATE OF COVERAGE NO. NCG12(This monitoring report is due it the Division no later than 30 days from the date
the facility receives the san n salts from the laboratory.)
FACILITY NA14IE h COUNTYw
PERSON COLLECTING SAMPLES - PHONE NO.
CERTIFIED LABORATORY Z Lab #
Lab # PLEASE SIGN ON THE REVERSE
Part A: Specific Monitoring Requirements
17 OiitFap Date 00340 3161b j . "00$30.
San No. iple Collected, ..' Chepucal:OxygenDenlAn t; li'ecgl`Coliform, Total uapepded Solids,
nro/div i In #per 100 nil m ./L
Bendimark 110 ' 1000:colonies ): 100`'
11 1
Note: If --you 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 nety motor oil per month? �— yes :no
(if yes, complete Part B) T
Part B: Vehicle Maintenance Activity Monitoring Requirements
O11.0011
4
Date
Sarpiple Collected,
mo(dd/vr
00556
0053D
00400
Oil and Grpase,
nte/L
Total Suspended Solids,
m e/L
pH, ;
Standard units
N N Motor Oil Usage,
Avtrage annual eaymo
Bendrmark
I— —
i0.
Inn
km 9_n
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
oce ueneral rermhr text.
STORM EVEN HARACTERISTICS:
DateI�(first event sampled)
Total Event Event Precipitation (inches): _
Date\(list each additional v t mnpled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
responses.
I
Mail 0Figinal and one copy to:
Attn: DWQ Central Piles
NCDEI R/ DWQ
1617 I;11 Service Center
Raleigh; NC 27699-1617
RECFR,/R::
AUG 2 5 2021
CENiTtAL FILEc
Dvv ,, S'ECT10ra'
SWU-248-102107
Page I of 2

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