NCG200355 DMR SW (5)

STORMWATER DISCiu RGI+., OUTFALL (S1)0)
GENERAL PIP RMIT NO. NCG200000
DISCHARGE MONI'T'ORING REPORT (DrVIR)
CK1111F[CATE Of COVERAGE No. NC:G200355
FACILITY NAME G(G i ti NJol nf ,n R�- __
I)EI2SON COLLLC'1'[NG SAMPL.El-
CI,11TIFIED LABORATORY�1�'
COUNTY
PHONE NO. 122 -
Pori- A• Rnorifid, Ntonilne•Ino 12euuirementit
:>iVlutl girt lit,4 iiitd otta ,y. flit SAMPLES CULLECTED DURING
CA.LENDAR YEAR:
i
�t��tt� a �.___
Atlh t:eitltal deli
(This numitoring report is due al the Division no
1617 Mn�l S'ettit�c� Centel later than 30 days From the dole the t,lcili(y
utLtg1, �Ini(li Crlilcilliiti 27699 X611 receives the sanrylling results lion/ the laboratory.)
Outtall Date
No. salliple
Collected
'Total
kadsilt
00530
00340.
110556..
0040.0
01113 01.119
00980M
01114
01094—
Tidal Suspended
SWIds
tit */1
Clteitileidl Oxygen
Deiaatid
Oil & Grease
li[I
Cadri11iUW7* Cbpperi +
/l rn`/1
lriiit
11119/1
Lead
_ WWI
Z
Ing/t
13enclitn �i tt -
-
100
121)
..30...
C0 - 9.0
0.001 0:007
N/A
U.O3
0.067
t If n value is in excess of the benchmark, or outside the benchmark range (ior PI -1), you must implement. the Tier 1 or Pier 2 responses in the General Permit.
'.l'olal recoverable.
Only complete .part B Y'this facility uses more than 55 gallons of nett motor oil per month.
purf n- Valtiri„ 14inintennnee Aetivity Monitoring Requirements
Oiitfiill .. mite
No Ssii11tple
inultltil/ r .
Tilt l Neiw lYDotor 011:..00530...
ltsiliifrill_ Wilge
tiiclic ...al/11iivatl11
0400
...00556.
Tothl S00ehded
Si,tids
ni /t .
lik .
s.ii..
se
Oil & Grease
iii}►jl
Benclitmark
100
6.0 9.0
30
Receive
[)
JAN 07sscii,U
o:
YOU MUST SIGNTHIS CL'lt'1'TI+ICA'I':LON FOR ANY .IN FORIVIAIION REPORTED:
"I certify, under penalty of law, /11th this document and till attachments were prepared under ny direction or supervision in accordance with a system designed to assure that qualif led personliel
properly gather and evaluate (lie information submitted. Based on lay inquiry of the person or persons who manage the system, or those persons directly responsible fin gathering the
inthrmution, the inlilrmation subiilitted is, to the best of my k,lowledge and belief, true, accurate, and complete. I uni aware that there the significant penaltics 1,11• Submitting fillse hllllrlllalloll,
including the possibility of tines and inprisoliment for knowing violations."
(Sign.11 y of Per
NCC200000 11
(Dote)
FormSWI-J-256
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