NCG060329 DMR SW (2)

STORMWATER DISCHARGE OUTFALL,(SDO)
MONITORING REPORT
GENERAL PERMIT NO, NCG060000
CERTIFICATE OF COVERAGE NO. NCG06
FACIIurI Y NAME g;-
PERSON COLLECTING SAMPLES _
CERTIFIED LABORATORY�JYJ,�_Cfirt Lab #
Lab
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR;
(This monitoring report is due at the Division no later than 30 ftys from
the date the facility receives the sampling res Its from the laboratory.)
COUNTY
® � g ryONE NO, G Z
9� MAR 1 1 20leLEASE SIGN ON THE REVERSE 4
CENTRAL FILES
Outfall Date 00530
No, Sample Total Suspended
Collected, Solids,
mo/dd/ r m
00400
00530.
00556
31616
pH,
Standard units
Chemical Oxygen
Demand,
m
Oil and Grease,
mg/L
Fecal Coliform,
Colonies per 100 ml
Benchmark 100
Within 6.0 — 9.0
120
30
1000
/
Y
<!,
i
FE
.73
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier2 responses,
See General Permit text.
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 Activitv MonitoAne Reaulrements
Outfall Date
No. Sample Collected,
mo/dd/ r
00556
00530.
00400
Oil and Grease, Total Suspended Solids,
m m
pH, New Motor Oil Usage;
Standard units Annual avers a al/mo
Benchmark
30
100
6:0 — 9.0 -
Note: 1f 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.
STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches):le
_
Date (list each additional event sampled this reporting peilod, 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 WU-249-102107
Pagel o1`2

9 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 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 possibility of fines and imprisonment for knowingviolations."
S WU-249-102107
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