NCG060186 DMR SW (10)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAG&Nfl NCG06.w-�­('3�� (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.)
FACILITYNAME re -P&,3
COUNTYPERSON COLLECTING SAMPLES Jere << PHONE NO. S(3L (p )386 -S SG 7
CERTIFIED LABORATORY « Lab # 77 '
Lab # y® PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements J�� ZQ
cEWr 16
Outfall Date •
�
; 00530 :,:,
,�',,;,`' ,
,,,,„'„ 00400
�
,•. :, ; ; , ,•
,,..., „0
;,�,.� • � Q��S�ta��;,� .�,, , .,, . � ••'..3'1616
- No. �� • S;am p le
„���:� Total' Sus ended' ; ; i�.,,
,� . , ,,,�, H
; l•;,,; ,. p
_ �
; C1iG Oxygen
,,, ,;
'Fecal Coliform,
bturid'ard unts
i
:' Demand
'•
9
mg/X,°"" ;,-',�oloriiesper-160
mo
aril
Benchmark' , .
U0'•,;',
h''n,,6'0-9.D
120
:i;,,0, , �•",.; ',,-{,1000
of / ols
n0 low
00 �.
03
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.
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 onitoring Re uirements
Outfall
No:
Date'
Sam' Collected,
mo/d'd/' r _
,-,�
00556
„Oil andFGrease, _
�
�m' /h' ,
06530 .
•e
.Total 8usp'ended Solids} :, -
' m %I, _ . ,,, �
' • 00,400 � ; ,•
pH, i New Motor Oil Usage,
crania hrd'�.iinits _ °Anniurll"avera agal/mo
Benchmark
- „•
„ " ',,30,Fr
100 - ,k
6i0,-•9.0 _
iwLo, a yvu icYuu a saiuPicu vaiuc ni 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.
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
e%znr Inn ,n•„n-,

"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
(Dad)
SWU-249-102107
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