NCG060158_DMR_20220921

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
GENERAL PERMIT NO.NCG060000 C = SAMPLES COLLECTED DURING CALENDAR YEAR: '
CERTIFICATE OF COVERAGE NO.NCG06 /_I J7 -7 (This monitoring report is due at the Division no later than 30 days from
? the date the facility
COUNTYreceives the samp ing results from the laboratory.)
FACILITY NAME �1 i L
I'S_ —
PERSON COLLECTING SAMP ES -� . PHONE NO. 2
CERTIFIED LABORATOR ' ' 1M 1Lab# REC �e ,/,^-. ,.
Lab# 'PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements OCT
Outfall Date 00530 00400 Db340 , , . 00556 31616
No. Sample Total Suspended pH, Chemical Oxygen Oil and Grease, Fecal Coliform,
Collected, Solids, Standard units Demand, mg/L Colonies per 100 ml
mo/dd/ r m /L m /L
Benchmark - 100 Within 6.0—9.0 120 30 1000
/
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 responses.
See General Permit text.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes Kno
(if yes,complete Part B)
Part B: Vehicle Maintenance Activity onitoring Requirements
Outfa❑ Date 00556 00530 00400-
No. Sample Collected, Oil and Grease, Total Suspended Solids, pH, New Motor Oil Usage,
mo/dd/ r m /L m /L Standard units Annual average 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: Mail Original and one copy to:
Division of Water Quality
Date ."rst event sampled) w Attn: DWQ Central Files
Total Event Precipitation(inches): 1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Date (list each additional event sampled this reporting period,and rainfall amount)
Total Event Precipitation(inches):
S WU-249-102107
Pnoa 1 of l

"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."
All('I--x Ojj�
(Siodature of Permittee) (Date)
SVX-249-102107
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