NCG060185 DMR SW (6)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG06 D (oO 1 X'5 n report is due at the Division no later than 30 days from
EiE elllity receives the sampling results from the laboratory.)
COUNTY St, r FACILITY NAME �. ra.r L L
PERSON COLLECTING AMPLES re -A% 1, JAN 2 6 2015 PHONE O. � �
CERTIFIED LABORATORY 9 Lab # :I!t_ CENT
Lab # pVCENTRAL
PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
Outfall
:' Date
..,.'
00530 ,M ;
,. �..
,, F;;., : ; 0'0{00
�: '/�•
•ail '6
',1��4:., 4�, .''li
No.
G.
,Y',,,;S;ampl LL6,;
i
., ;x. ;Total' Suspend4d,.,,,r,,'
; ChOmial'.0 gen"
..I,i: .�
.;, Oil',and. Greasef :: , , a , , ' Fecal Coliform'
m'
, i
;d rdunits
r$oh
;:,,,.S�t' nda
a rd' units
:. Demant� :.g
d ' ''
nl'''' 1 }` es er l
ColonI QO ml
; `•,. - 610.-.9.0`, '
_ _
,;,`y';•i',
Benchmark-..,,..
`
120'
30.,. :, ;1000
00 I
- p)
b low/
AL. F... Tl ...... _
_,. ,
1•U«. LL yUu , Ui,u, L a Sarriplea value in excess or 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 Activi Monitorin Re uirements
OutfallDate'
00530
-00,400-,j,...
No.. Sample Collected;
Oil andAGrease; ,.
.Total gusoended SOlidb,
:, • • - ; pH s " I.
New, otor Oil Usage,
mo/dd/' r _
[ii' /I,=
m'
, i
;d rdunits
-Anuuel" avers a al/mo
Benchmark _
4; ".; 30'. ' 1
100 = x'' i,
; `•,. - 610.-.9.0`, '
_ _
Note: If you rennrt a samnled ual„P;n PYi PCO l,fil,P L T......_,. .. ,.. __ ___._]J_
H. 0, um benclum j, value, ui uuLslue We benchmark range tor pH, you must implement Tier 1 or Tier 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):
Mall Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Q\U/TT')An IA'1IA7

"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, 'iricluding
the possibility -of fines and imprisonment for knowing' violations."
(Signature of Permittee) (Date
S WU-249-102107
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