NCG120053 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG120000 SAMPLES COLLECTED DURING CALENDAR YEAR: 201,5
CERTIFICATE OF COVERAGE NO. NCG12 DOS 3 (This monitoring report is due at the Division no later than 30 days from the date
14,101611
�� / , ,s the facility receives the sampling resul from the laboratory.)
FACILITY NAME L N ! ✓ IFC E I Y ONE NO. Cw a rem S 2_
PERSON COLLECTING SAMPLES 601
CERTIFIED LABORATORY4�' LQ - �a\\.P Lab # !AQ
Q44 -\�,,�..1�!!, \,s Lab # tZ OCT 0 g 2015 PLEASE SIGN ON THE REVERSE
Part A: Specific Monitoring Requirements
CENTRAL FILES
Outfall
No:
Sample"G�ollecte
,k - .�.
yr.
Chemical 0Av 1rouriF�"Q"f;~s
.�+gi f' �"" ''fn%�:' ,�•:';_;'i :-¢,.•:'-'
r:: I.:.r:" # "'eit10,0,F:, s,;,. ;.;,,;,.
:�=
:Total S&s' endhdSgli
�H 3;`,x,5.
:;,.x _ ., ."•.. ;
Benchmark
_
30 ,
;r,���"
G�',:••.�r<'�„.
n -I-
-1-
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 onitoring Requirements
Outfall
No.
Date -
Sam ke':&llected;•
mo/ddl
OQ55'6: ' 00530 : d' ;,(►Q4Q9 ";`;'
' Qil_and Grew; . ;) Qtaj;Suspended Soli =, �,�; - .)?7rI
m m :Silty>lYuit$
'
_ .r`-,, _, - i
New M64 #Oi�vils'agc;
Avera dbnntia).
Benchmark
30 ,
,100 s„r
n -I-
-1-
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 "Pier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches):,
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Attn: DWQ Central Files
NCDENR/ DWQ
1617 Mail Service Center
Raleigh, NC 27699-1617
SWU-248-102107
Page 1 of 2

STORMWATER DISCHARGE OUTFALV(SDO) ,
,MONITORING REPORT' -
"L 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
Zirectly 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). N, ; (Date) _
SWU-248-102107
~' _ - Page 2 of -2' „ .