NCG090009 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCGO90000
CERTIFICATE OF COVERAGE NO. NCG09 0 009 �^
FACILITY NAME 1 wc--
PERSON COLLECTIN SAMPLF�Sm A
CERTIFIED LABORATORY >Z I Sn, L i4f3.r Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2p1S-'
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sam ling results from the laboratory.)
COUNTY WAO
PHONE NO. (7o y) 932-- 30
PLEASE SIGN ON THE REVERSE 4
Outfall
No:.
. Date
Sample Collected,
mo/dd/ r
1 01027 01034 01051
Total Cadmium, Total Chromium, Lead,
u u u
Benchmark'
-
1 1 1 1000 33
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.
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 Activitv Monitorine Requirements
RECEIVED
MAR 2 7.2015
CENTRAL FILES
DWR SECTION
—.-Outfall Outfall .
-,. No:,
Date
Sample Collected,
mo/dd/ r
00556 00530 00400
Oil and Grease, Total Suspended Solids, pH, New Motor Oil Usage,
MWL mWL Standard units Annual averse galfmo
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 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date 3 ." (first event sampled)
Total ent Precipitation (inches):
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
SWU-255-102107
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"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."
Avfill/�&
(Sighature of Pe ' tee)
(Date)
SWU-255-102107
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