NCG030401 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG030000
CERTIFICATE OF COVERAGE NO. NCG03
FACILITY NAME i6eZ fl t3
PERSON COLLECTING SAMPLES TZ,uw (,✓��
CERTIFIED LABORATORY Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR:
(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
PHONE NO. ( )_
PLEASE SIGN ON THE REVERSE 4
Outfall Date
No. Sample Collected,
mo/ddI/ r
00530
00400
01051 00556 78141
Total Suspended Solids, pH,
m Standard units
Lead, mg/L Oil and Grease, Total Toxic Organics',
m m
Benchmark - '
100
Within 6.0 — 9.0
0.033 30 1
Noie: it 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.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month's _ yes no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Renuiremenk
Outfall Date 00556
No. Sample Collected, Oil and Grease,
mo/dd/ r m
00530
Total Suspended Solids,
m
60400
pH, New Motor Oil Usage,
Standard units Annual average al/mo
Benchmark - 30
100
6.0--9.0 _
Notc: a you report a samplea Value 1n excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I 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):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
S W U-245-031308
Page I of 2

1 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or
manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject
to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use the definition as found in 40 CFR 469. 12; for
electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use the definition found in 40 CFR 469.31).
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may be waived. The
solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities electing to employ the
TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management
plan included in the Stormwater Pollution Prevention Plan."
(Date)
"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 sub ' ed. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible or gathering the information, the information submitted is, to the best of my knowledge and belief,
tr ccurate, and c mplete. I am aware that there are significant penalties for submitting false information, including
e pos 'bility of fins and imprisonment for knowing violations."
(Date)
S WU-245-031308
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