NCG060310 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO)
MONZTORiNG REPORT
GEPIERAL PERMIT NO, NCG060000
CERTIFICATE OF COVERAGE NO, NCG060 ,S/C
YrACTi.ITY NAMEJ1y ±£rd2S
PERSON COLLECTING SAMPLES _i¢FL
CERTIFIED LABORATORY Lab #
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR; =` r
(This monitoring report is due at the Division no later than 30 days from
�the date the facility receives the sa ingresul�rom the laboratory.)
LL ei�fL/
PHONE NO. ?QV— 22 Z
PLEASE SIGN ON THE REVERSE 4
RECEIVED
Outfall
No,
Date
Sample
Collected,
mo/dd/ r
00530
00400
00340
00556
31616
Total Suspended
Solids,
m
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
.,o
.�
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 Tier, 2 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 Activity onitoring Re uirements
Outfall
No,
Date 00556
Sample Collected, Oil and Grease,
mo/dd/ r m
00530
Total Suspended Solids,
m
00400
pH, Now Motor Oil Usage,
Standard units Annual averagegal/mo
Benchmark
30
100
6.0-9.0
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 Tier 2 responses,
See General Permit text.
STORM EVENT CHARACTERISTICS:
Dated (first event sampled) �J
Total Event Precipitation (inches): ,/
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Flies
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
MAR_ 14 2016
ENTRAL FILES
)WR SECTION,
S WU-249-102107
Pagel of 2
0

I .
" 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 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. T am aware that there are significant penalties for submittiing false information, including
the -possibility of fines and imprisonment for knowing violations."
( gnature of Permittee) (Date)
I
SWU-249.102107
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