NCG120069 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG120000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG12 OOG �) (This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITYNAME Ne" N4hdve-e Coy,^t�, LC'�ll COUNTY New HG^ove✓'
PERSON COLLECTING SAMPLE(S) t,4.9... 6 PHONE NO. (2LQ--) 93- yy 12
CERTIFIED LABORATORY(S) Lab #
Lab # (SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge
Part A: Specific Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00340
31616
00530
Total
Flow
Chemical
Oxygen
Demand
Fecal Coliform
Total
Suspended
Solids
pH
mo/dd/ r
MG
unit
# per 100 nil
m
N .0; s
unit
al/mo
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 R- Vehicle Maintenance Artivity Monitarine Renuirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
Oil and
Grease
Toatl
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
m
m
unit
al/mo
STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches):
Event Duration (hours):
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
RECEI V IE®
JAN 08 &)
CENTRAL FILES
SWR SECTION
Mail Original and one copy to:
Attn: Central Files
NCDENR/ DWQ
1617 Mail Service Center
Raleigh, NC 27699-1617

"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."
(Signature of Permittee) (Date)