NCG060186 DMR SW (4)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO. NCG06_ , O 1$ (p
FACILITY NAME Wa.,tni F--t.-,s L L
PERSON COLLECTING SAMPLES Jct'co+1 ADW ce,
CERTIFIED LABORATORY Ra,,,,t �¢ Lab It
_ Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: D
(This monitoring report Is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY 5urt-4
PHONE NO. (3
PLEASE SIGN ON THE REVERSE 4
Outfall Date 00530?r,` •` 'i :r; .00400 10.0340 1
No. y „r' Sample. ,r.. ,.,1,,,..,.Total• Suspendgd' a ' i'i ".`-pH,
..o
„';. ChGmi�hf.Oed): ;,a0i1',,and Gre$se+,'I 'Fecal'ColIform
Solidi ° r' ,y,$taii'dard"units =' 1)einaitl IIiR
§ �.
;'.;'°';,• ,;:Y,,,Y,;_ .i,,.y, a„r., ,.,.; ':' a;
(I/ r•. I Iti . !,' .Ih's - '• I ' r.,. i mWL',.',1,pi
Benchmark'
Ob �tttn'i.6'10 �•� K, 4
_ 120 a+,,..,' ,•'30,,:,'Y L'o :x',1000
0 0 IcM/ `
dol
0
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement T� 1 or Tier 2 responses.
See General Permit text. RECEIVED
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? — yes no FEB 19 2015
(if yes, complete Part B) —
Part B: Vehicle Maintenance Activity onitoring Requirements DWR CENTRAL FILES
Outfall, Date' ".:00556'•,: 00530 00,400-1;'
No: Sample Collected, .,.Oil and -Grease; Total us ended
'mo/d'd/' P. Sglide� ; ,pH;'' I„ • NIeW.Motor Oil Usage
r' 1rrt /I;•' m''/L,_ ” $tandard;unita e'
Benchmark Anuu�ll'avera a gat/mo
Note: If you report a sampled value i
See General Permit text. n excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
STORM EVENT CHARACTERISTICS: Mall Original and one copy to:
Division of Water Quality
Date (first event sampled) 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):
curer')An innin�r

"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 pay 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."
8 1s
(Signature of Permittee) (Dat6)
- -; SWU-249-102107
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