NCG030151 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
/(v- ,37 MONITORING REPORT
GENERAL PERMIT NO. NCG030000�f SAMPLES COLLECTED DURING CALENDAR YEAR:
�
CERTIFICATE OF COVERAGE NO. NCG03 (This monitoring report is due at the Division no later than 30 da s from
FACILITYNAME 14eh"Me
PERSON COLLECTING SAMPLES-
CERTIFIED LABORATORY F16-ifeh Lab Lab #
Lab #
Part A: Specific Monitoring Requirements
y
the date the facility receives the sa ling rfecs�ults from the laboratory.)
COUNTY 1,4-4 X
PHONE NO. o (v- aO4
PLEASE SIGN ON THE REVERSE 4
Outfall
No.
Date
Sample Collected,
mo/dd/ r
00530 00400 01051 00556 78141
Total Suspended Solids, pH, Lead, mg/L Oil and Grease, Total Toxic Organics',
m Standard units m
Benchmark
-
100 Within 6.0 — 9.0 0.033 30 1
wore: It 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 _no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity onitoring Requirements
Outfall
No.
Date 00556 00530 00400
Sample Collected, Oil and Grease, Total Suspended Solids, pH, New Motor Oil Usage,
mo/dd/ r mgtL Standard units Annual averse gallmo
Benchmark
- 30 100 6.0-9.0 -
Note: It 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 (O—q— 15(first event sampled)
Total Event Precipitation (inches): 41 4
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
S WU-245-031308
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1 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 of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject
to the requirement to sample (for metal finishing use the definition as found in 40 CFR 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 CFR 469.22; 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 so certify, and the requirement for TTO monitoring may be waived. The
solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the
TTO monitoring waiver, the discharger shall sign the following certification 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 or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management
plan included in the Stormwater Pollution Prevention Plan."
Name (Print name)
Avol^-T M(YA150��it
Title Print itle)
(Sig e) (Date)
"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."
-�elal / 30 As
(Stidatuife f &tee) ( te)
S WU-245-031308
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