NCG060012 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: ���
CERTIFICATE OF COVERAGE NO. NCG06 �a / �- (This monitoring report is due at the Division no later than 30 days from
FACILITY NAME t L Ci the date the facility receives the sampling results from the laboratory.)
PERSON COLLECTING SAMPLES 2a COUNTY
CERTIFIED LABORATORY PRONE NO:' LI _
Lab'# /
_PglMbtn les tit�_Lab'#
PLEASE SIGN ON THE REVERSE -�
Part A: Specific Monitoring Requirements
Outfall Date 00530 03
No Sample
2015
Collected
Total' Suspended
Sohds S
p _
i`Standard'unrts
Cliertucat Oxygen
',
Oil and Grease ..:
Fecal Goltfo r.
E NTRq FILES
-... rrio/dd/ r
'
/L
Demand
a
m; „
Colonies er 100' nil
p
WR SEC O
T
Benchmark `. - .
m
100
m' %L
120
al �lol"
w'
< leo
�o.ca
.1000
NA
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH,
See General Permit text. you must implement
Tier 1 or Tier 2 responses.
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 Activity Monitoring Requirements
Outfall`00556
00530 00400
No Sample Collected; Oil and Grease' Total Sus ended Sohds
mo/d'd/ r �m /I, Sta pI3, i New Motor Oil Usa e,, ..
P ,
Ing
nual avera a al/mo
/L
Benchmark :; 30
nda d
r units An
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark ra
See General Permit text. nge for pH, you must implement Tier 1 or Tier 2 responses.
STORM EVENT CHARACTERISTICS:
Mail Original and one copy to:
Date ld i (first event sampled) Division of Water -Quality
Total Event Precipitation (inches): �� Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina, 27699-1617
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
SWU-249-102107
Puerto 1 .,r')

"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 properlygather 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 possibilitxo nes and imprisonment for knowing violations."
L.� 1
q
n (Signature of Permittee) (Date)
S WU-249-102107'
Page 2 of 2