NCG080773 DMR SW

STORMWATER DISCI.., f„GE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG08.000 E .`
CERTIFICATE OF'COVERAGE NO NCG08 ` COLLECTED DURING CALENDAR
SAMPLES
YEAR: �©
(This monitoring report is due at.the Division no-dater_than 30.days from
FACILITY NAME a receives the s „ p i resul fr m the.laboratory.)
�U ..t/ �v �n rt� A 'Mire TY ��
PERSON COLLECTINGSAMP,LES ; ,:
CERTIFIED LABORATORY '` JAN, _� 2016PHONE NO C L
Lab
Lab # CENTRAL FILESLEASE SIGN ON THE REVERSE
Part A: Vehicle Maintenance Areas M hitoring Requirements SWR SECTION
Did this facility perform Vehicle Mainte once Activities using more than;53 gallons of new motor per month? —yes no
(if yes, report your analytical results in th table immediately below) —
Note: If you report a sampled value in ex ass of the benchmark value, or outside the benc
hm
See General Permit text. ark range for pH, you must implement Tier 1 or Tier 2 responses.
Dt'ePart
Of ButµfaOillil/w�)ia'-i te+�rI Se aI rf ali i tors and
eco AEI 1 , { I Containment
ontainment Areas ai++t� Petroleum By,j + ul/k Stations tati015 an+d Terminals
;i
�
a
f iu ,,0++ ,II .,�amDl��l:.OIIP.RtPllil f 5 �n '+t (l 1 !+
STORM EVENT CHARACTERISTIC
Date % (first event sam led)
Total E e t Precipitation (inch s): ' e
Date (list each ai
Total Event Precipitation
event sampled this reporting period, and rainfall amount)
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
S WU-250-102107
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"I certify, under penalty of law, that this document and all attachments were prepared under my dr rection or
supervision inaccordance'vvith a -systein�designed to -assure that qualified personnel properly gather, and,evaluate:the.
information submitted:: $aced on'caiy inquiry of the person orlpersons°who manage the system, or tf ose persons
Y' P g g ,
directl res onsible for atherm' the information'the:uiformation°submitted is, to the best of my k; towledge,and belief,''
true, accurate,=and complete. fi, am'aware thatahere are significant penalties for. submitting false mL rmation;`iticluding
the possibility of fines and imprisonment for knowing violations." _
SWU-250-102107
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