NCG030576 DMR SW

STORMWATER T ARGE OUTFALL (SDO)
0 MON1- AING REPORT
GENERAL PERMIT NO. NCG030000 SAMPLES COLLECTED DURING CALENDAR YEAR:/
CERTIFICATE OF COVERAGE NO. NCG03 O S 7 6 (This monitoring report is due at the Division no later than 30 days, from
FACILITY NAME Mu e; ((e YSj-e4 ,n S the date the facility receives the sampling results -from the laboratory.)
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PERSON COLLECTING SAMPLES � COUNTY
CERTIFIED LABORATORY ' PHONE NO. (9 ( O) Q(o $ - cZ ;�, 4 f
T i3 L Lab #
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
Oufflin
P'teoi
No, Sam leCdll $duds;
Peed. eai;g ;'Pill
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ruillfta� ; ; ..., ., .OWL
hmark' Y ltlb = ; r
Yj a ��, is • �.Y,'1�LLlII'�a� 9► L .e :�, { a :4'.• r i 104{/J17�' - 30-
MVP®
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark ran a for H 2 6 1(1
See General Permit text. g p , you must implement Tier 1 or Tier 2 resp
R �ECFILES
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? no ON
(if yes, complete Part B) _yes
Part B: Vehicle Maintenance Activity
Monitorin Re uirements
Outfall '. ~ i�at:." . 21
0.6556:
No: Samplh Gotlecte1"""00 0� .�' '' tl0-+d00
nio/t#t)1 : ,;Uii gnd Gt ease;'„ To SueFe� did,.8 ;lids;' r d11 Uea
4, P'+ New Mgto _ g
Benchmark . ' &t "grd uni Ariii I',er$ $Utiro
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark for H
See General Permit text. �a p ,you must implement Tier 1 or Tier 2 responses.
STORM EVENT CHARACTERISTICS:
Mall Original and one copy to:
Date,V/ / (first event sampled) Division of Water Quality
Total Event Precipitation (inches): Attn: DWQ Central Files
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):
SWU-245-102107
Page 1 of 2

Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or
manufacture cathode ray tubes. For purposes of this permit the definition ofTotaILT,oxic Organics is that definition contained in the EPA Effluent -Guidelines for -the facilitysubject
to the requirement,tosatnple.,(fgr..metal finishing.use the.definition.as fou ndsin.+401CFR 433.11; for semiconductor manufacture use.the definition•as-.found in 40 CFR 469:12; for
electronic crystal. manufacture.use the, definition -as -found in=40 CFR469.22; and,for-cathode ray tube manufacture use the definition found in 40 CFR 469.31).
Facilities that incorporate a solvent management plan• into the Stormwater 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. Forlthose facilities allowed such a waiver, the
discharger shall sign the following,certificatioh 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-orareas which are;exposed to rainfall or stormwater
runoff has occurred since:filing.the last discharge-.monitoring.report: I further -certify that tin acility.is.implemendu&the allthe pr9visions of -the solvent.management
plan included in.-the.Stormwater Pollution -Prevention Plan."
Name (Print name)
Title (Print title)
nV6-4� �
y i� zc�is
(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_aystem designed to assure that qualified personnel properly gather and evaluate -the
information submitted. Based-onmy inquiry of the person or persons who manage the system, or -those persons
directly responsible for gatheringthe 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."
h zs,,� 4. f 2 3/ Z O 1.5
(Signature of Permittee) (Date)
SWU-245-102107
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