NCG120005 DMR SW

STORMWATER DISC' ZGE OUTFALL(SDO)
MONITORh1G REPORT
GENERAL PERMIT NO.NCG120000 SAMPLES COLLECTED DURING CALENDAR YEAR: 2O/5
CERTIFICATE OF COVERAGE NO.NCG12 U 005- (This monitoring report is due at the Division no later than 30 days from the date
4 Ftie'facility4-eceives the sam results from the laboratory.)
FACILITYNAMEqubeson C . �c sAt ""Iw COUNTYP'1(obesoi,
PERSON COLLECTING SAMPLES sA„n I�oserS JUL 2 4 PHONE NO. (9/o )
CERTIFIED LABORATORY ¶e l_ Lab# 37 2015
Lab#
CENTRAL FILES PLEASE SIGN ON THE REVERSE °-
DWR SECTION
Part A: Specific Monitoring Requirements
31616444._ r fi
�
�i�
X00530
Sample Collected, Fecal Coliform;;5 4 �- � Cotal suspdd 5o
ds, ,
mo/dd r #per 100 m i ei ii J Benchmark -
S O !k)o rIe1..Z
Soo 2 Nfl Flo�,
soo !L)0 Ftau
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 Date 00556 00530 00400
No. Sampie,collected, Oil and Grease, Total Suspended Solids, pH, New Motor Oil Usage,_
mo/dd/yr mg/L,• mg/L Standard units Average,annual gal/mo
Benchmark �� G-'r • 100 "i;�
6.0=9Q ',I3 �'
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.
STORM EVENT CHARACTERISTICS:
Date (first event sampled) Mail Original and one copy to:
Total Event Precipitation (inches): Attn: DWQ Central Files
NCDENR/DWQ
1617 Mail Service Center
Date (list each additional event sampled this reporting period, and rainfall amount) Raleigh,NC 27699-161-'
Total Event Precipitation (inches):
S WU-248-102107
Page 1 of 2

STORMWATER DISC' IGE OUTFALL(SDO)
MONITORIr.G REPORT
GENERAL PERMIT NO.NCG120000 SAMPLES COLLECTED DURING CALENDAR YEAR: '4i/5
CERTIFICATE OF COVERAGE NO.NCG12 000 5- (This monitoring report is due at the Division no later than 30 days from the date
the facility receives the same ' results from the laboratory.)
FACILITY NAME obe5pn C,�. ��"� (�a$ke COUNTY b�� N
PERSON COLLECTING SAMPLESTRIcpr o firs PHONE NO. ( 94) ) 01'-3Pra
CERTIFIED LABORATORY TBL Lab# J°T
Lab# PLEASE SIGN ON THE REVERSE -�
Part A: Specific Monitoring Requirements
Outfall Date . 00340: 31616 . : -.00530
No Sample Collected, Chemical OxygenDemand, • Fecal ColiforM,F rh,.,'t k
mo/dd/yr F mg/L: 5;� #per 100 ml." ` ' Total Suspended Solids,
Benchmark - t:k f i�. 100Q'colomes
00
00 No /766
SDaS 4 r
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 Date r 006 00530 • 00400
No. Sample Collected, Oil and pg l� ,Total Suspended-Solids, pH, New Motor.Oil Usage,
mo/dd/yr mg/1 �' ' ' a m Standard units Average°annual''gal/mo
Benchmark 6.0
Note: If you report a sampled value in excess of the benchmark value,or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date (first event sampled) Mail Original and one copy to
Total Event Precipitation(inches): Attn: DWQ Central Files
NCDENR/DWQ
1617 Mail Service Center
Date (list each additional event sampled this reporting period, and rainfall amount) Raleigh,NC 27699-1617
Total Event Precipitation(inches):
S WU-248-102107
Page 1 of

• STORMWATER DIf ARGE OUTFALL(SDO)
MONITOI.ING 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, includin
the possibility of fines and imprisonment for knowing violations." g
■
(Signature of Permit-tee) 7— /7.
(Date)
•
S WU-248-1 02 1 07