NCG060186 DMR SW (9)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCGO60000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCS€ (This monitoring report is due at the Division no later than 30 days from
e,�athity receives the sampling results from the laboratory.)
FACILITY NAME �J� �A!A. `-rr^ � COUNTY o a
PERSON COLLECTING LES –3u cr- o.. t PHONE NO.
CERTIFIED LABORATORYYaeg. Lab # 3223Z OCT 2 6 20115
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
CF_iNT fiL FILES
MNIP, SEG M3N'
Outfall . s" Date
00530 _ :' ,; ;<+':
,, �;, 0000
_
;;,.0,0340 !,:.
+1eli'
'''"'' , ;
'„ AQSSsta'a
,, ..3'1616
No. ;;',, 'Sample ' ;,'
1. ',.,.TotAI'Suspended''a;ic,'
H
PHI,
Gh migul',O
� g'
� •
-,;,;, � ' Fecal Coliform,"•
i
ari'd'ard"units
; ; .
- i,.Demant�
�,',
,',,4;;Oil,and;,Crreasea
;,'
C oloiiics per•100 inl
;•
.,'''t?►g
.
Benchmark'.,.20,.:'
Do( o ►
o
voZ
®03
– yvu 1UP01 L a aanip ed 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.
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 Mnnitnrinu Rennirpmn.,tc
Outfall Date'
No: Sample Collected,
-- - 00$56 „, ,
Oil and Gre'ase;,,
00530 s `00.400--'111
.Total Bus ended Solid's :, ; '
P v . ,PH;4 ;, ,New Motor Oil Usage,
Stalidard,units-Ami a al/mo
Benchmark
100:
-'—F
u J4111iJ1VLL vain 111
mit
See General Pertext.
STORM EVENT CHARACTERISTICS:
Ul Luc uonolunafx value, or outside me benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
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
QUM ')nn tnlin�7

"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."
(Date
S )ArU-249-102107
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