NCG030440 DMR SW (4)

STORMWATER DIS,--iARGE OUTFALL (SDO)
MONITORING REPORT
,GENERAL PERMIT NO, NCG030000
CERTIFICATE OF COVERAGE NO. NCG03 0
FACILITY NAME TirytKep-5jee� Ikz'All, 1AWf—
PERSON COLLECTING SAMPLES p I
CERTIFIED LABORATORY CI c'A 'Lab #
—Lab #
Part A: Specific Monitoring Requirements.
SAMPLES COLLECTED DURING CALENDAR YEAR: 0 ,
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the LLsnmp' results from the laboratory.)
COUNTY laboratory.)
PHONE NO.
PLEASE SIGN ON THE REVERSE 4
Note: If You report a sampled value. in excess of the benchmark value,
See General Permit text. or outside the benchmark range for pH, you must implement Tier I or
Did this facility Perform Vehicle Maintenance Activities using more than 55 gallons of new motor per month?
(if Yes, complete Part B) --yes
Part B. Vehicle Maintenance Activi
Monitorin Re ui�rej
Outfall ."Date i
S
Note: If you report a sampled value in excess of the benchmark value, or outside the
See General Permit text. V
STORM EVENT CHARACTERISTICS:
Date ))-/?-)L/(flrst event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and,
Total Event Precipitation (inches):
562T
sed 0 (06-4 eJjX3) LA1enpap
130
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ON El molaq SSSJppe A19AIJOP J0JU0
S9,k[l UW91!WOAJ1U9A9.41PSSajPPefW
1AJOA119C] jO'9jU1CJ ",)I (9weN pajupj) AG
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RECEIVED
FEB 2 9 2016
DU 10
Sample CP.Wted,
DWR SECTION
mo/dd/.v.
2210
0000 7562 1295
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SAMPLES COLLECTED DURING CALENDAR YEAR: 0 ,
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the LLsnmp' results from the laboratory.)
COUNTY laboratory.)
PHONE NO.
PLEASE SIGN ON THE REVERSE 4
Note: If You report a sampled value. in excess of the benchmark value,
See General Permit text. or outside the benchmark range for pH, you must implement Tier I or
Did this facility Perform Vehicle Maintenance Activities using more than 55 gallons of new motor per month?
(if Yes, complete Part B) --yes
Part B. Vehicle Maintenance Activi
Monitorin Re ui�rej
Outfall ."Date i
S
Note: If you report a sampled value in excess of the benchmark value, or outside the
See General Permit text. V
STORM EVENT CHARACTERISTICS:
Date ))-/?-)L/(flrst event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and,
Total Event Precipitation (inches):
562T
sed 0 (06-4 eJjX3) LA1enpap
130
[U9A1
Jac] UO 109110c) p FIA Pe
esipueqoj9Vq jol Idt9oaH wnjeU p polals
w,ssejdx_q 11M AW011d ] dIVIN P9!J
odA_L
ON El molaq SSSJppe A19AIJOP J0JU0
S9,k[l UW91!WOAJ1U9A9.41PSSajPPefW
1AJOA119C] jO'9jU1CJ ",)I (9weN pajupj) AG
i eassalppv
jL1a6V
2 resr)ou
RECEIVED
FEB 2 9 2016
CENTRAL FILES
---- - ------------- - -------
- - ----------
DWR SECTION
7012
2210
0000 7562 1295
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Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic crystals, or
manufacture cathode ray tubes..: For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject
to the requirement to sample (for -metal finishing use the defiiiition as found.in 46 CFR 433.11; .for semiconductor manufacture iise the definition as found in 40 CFR 469.12; for
electronic crystal manufacture use the'defmition� as found in 40 CFR 469.22; and' for cathoge ray tube manufacture use the definition,found in 40 CFR 469.31).
Facilities that incorporate.a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a waiver, the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management
plan included in the Stormwater Pollution Prevention Plan."
Name (Print name
Title (Print title)
X/,—
(SignaaLL== _ (Date)
"I certify, under penalty of law, Yhat 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 possibiliof fines and imprisonment for knowing violations."
of Permittee)
(lYate)
S WU-245-102107