NCG060185 DMR SW (11)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO. NCGOC '_16V9
FACILITYNAMEw-yna b•cntis
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY _ �`c r /�I;, w I Lab•# : 173;
Lab #
Part A: Specific Monitoring Requirements
I mo
SAMPLES COLLECTED DURING CALENDAR YEAR: I
(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 _54.rrr�
PHONE NO. 036) 3 $6 s $fO 7
PLEASE SIGN ON THE REVERSE 4
Outfall
Date
'-
•�,.�.. •�, :,�: �,
.�,,;' •,,,,,,•,OQ$S�'t,!,;,,i �,.,
�r�, �•'„3'>L616 -p
No.
,�� S;uinple ''
-„',
.• :Total'Suspend¢d',',i';'
i!,! pH,
'!, tl ”, '
?Ghgmic�al'.O en'
��
I
Oil.,and. rea5e a
:! 'Fecal Coliform, .
Qollected',ri,
; : r, ;•,;,.;:.
„Solids
. .
;. r;,!45'tstii'dar`,d' units
,'i,:'
. - r.-.
! emantl ,, ''
'•
.+a;
'! mg �_•"
1Qib k1T
mo/dtl/ rcwk
;, , �t, ;;;°.., •
'''�' ' '?•' ''",P.''
'W
;,,,; ., ,'! ,!,,
;;' .,
,Colonies''per
Benchmark
.,,
h1ri,G.'0O .
. ,!
0004
00/
,1'.,
wr-`-- •r----- -
INULM a yuu repun a sampled value in excess or 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 Activity Monitoring Requirements
Outfall Date' 00556 • , „
No: Sample Collected, .Oil an&Grease;,
'mo/dd/' r _ I•M1� ,
00530 '00.400'!.• .,•, ��
Total 8usp'ended Sglidst ply;" New 1Vlotor Oil Usage,
_mk /I, ;'
St -"nudl'av6ra a al/mo
Benchmark
AT_ rr---_.
IWW: 11 yuu icpviL a salnpicu vaiuc in excess of me benenmarx 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
15 2016
�AL FILES
SECTION
QA1rT T 7 A n 1 n'1 1 n'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 any 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
(Dat
SWU-249-102107
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