NCG190018 DMR SW (6)

CERTIFICATE OF COVERAGE NO. NCG:
FACILITY NAME QRd-DY - it/It1'TE
PERSON COLLECTING SAMPLES_
CERTIFIED LABORATORY 674"A
Part A: Specific Monitorinc Requirements
STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG190000
DISCHARGE MONITORING REPORT (DMR)
00'
Lab #
Lab #.
SAMPLES COLLECTED DURING CALENDAR YEAR:
RECEIVED
MAR 16 2015
CENTRAL FILES
DWR SECTION
(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 Pt ff
PHONE NO. (0752-211)
Outfall Date
00530
00400
00556
01119
01104::
01094
Q1114; ;
No. Sample Collected,
Total Ra' fall, ::
Total Suspended.
pH,
Oil &Grease,
'Copper
Aluminum
Zinc:' ,
. 'Lead
mo/dd1::rme.
Solids
Standard: units
.: m "
m
Benchmark:-
=
100
Within 60 9.1.W....
30
0.007
0.75
Ol)67
0.03
A- 2.
7.0
L .a
L.O. oto
410.106
0.28S
Gd. 005
' If a value is in excess of the benchmark, or outs
Total recoverable.
3 These benchmarks are water hardness dependar
Mail:original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION
"I certify, under penalty of law, that this
system designed to assure that qualified p
persons who manage the system, or those
knowledge and belief, true, accurate, and
possibility of fines and imprisonment for
of Permittee)
Permit 04e:10/1/2009-9/30/2014
the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit.
Values shown based on.a hardness of 50 mg/L.
ent Management Plan Certification:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement
for managing solvents, I certify that to the best of my knowledge and belief, :no leak, spill, or dumping of concentrated
solvents into the stormwater or onto 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 all the provisions of the'Solvent
Management Plan included in the Storm ar ollution Prevention Plan."
Q 3•IZ•�5
gnature of Permittee) (Date)
R ANY INFORMATION PORTED:
it and all attachments were prepared under my direction or supervision in accordance with a
properly gather and evaluate the information submitted. Based on my inquiry of the person or
directly responsible for gathering the information, the information submitted is, to the best of my
e. I am aware that there are significant penalties for submitting false information, including the
violations."
(Date)
SWU-253-092309
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