NCG060185 DMR SW (10)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITO
GENERAL PERMIT NO. NCG060000 C
CERTIFICATE OF COVERAGE NQ G0�6i�ii6dr,
FACILITYNAME �s_yd<
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY Ti•c� Qom` �.i t �_) Lab # 713
Lab #
Part A: Specific Monitoring Requirements
OCT 2 6 �3y
RIlVG REPORT'
1 lfJ, C S
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY
PHONE NO. 7
PLEASE SIGN ON THE REVERSE 4
.,Outfall . Date
:; ,:
00530
Total Sus ended
p' Solid's, :,
-; m' /L,
a .,•
y,,,,, S. =t,a;,; ' ;, ,'„3'� 6'16
Nd. Sample
.Total'Suspended'-;;i','!,;..,,;,;;
”
pH;
CliemicaT.O en
?�'
Oil.,and. Grease.'Fecal Coliform
(4pllected' ,tr ',
,Solids ;'
4+,
',.,!!.S'taiidard"units`
: - ..
„' :Demand
°1g olomes'per-1- 0
/Ir',.,?l,," C Q
mo/iI
;;
;, aril
Benchmark .. _
Watliiri.G:0-9'.0'
120
r..
:ir., 3 0,,',,,' ! +' 1000
00 - aoi
o ow
— y.,- I�FUI L a aamplQu value in excess of the bencnmarK value, or outside the benchmark range for pH, you must implement Tier 1 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 1VManitnrino Re !v jrnm encs
Outfall Date'
No.. Sample Collected;
mo/d'd/' r -
Benchmark _ ; ;,,,
00556
..Oil a'nd-Grease
�,
iii y4 '
;;;,: 30:,,',!
00530
Total Sus ended
p' Solid's, :,
-; m' /L,
'00400:1.,
pH;' New Motor Oil Usage,
Stand rd'units ,-"nuAl'avera a al/mo
_
Note• If
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):
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 Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
QX1rTT')nn tmin7

"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, I am aware that there are significant penalties for submitting false information, including
the possibility of fines and imprisonment for knowing violations."
(Signature of�Permittee)
5
--:5'.
(Dat
S WU-249-102107
Page 2 of 2