NCG100040 DMR SW (4)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
CERTIFICATE'OF,COVERAGE NO. NCGI00040 SAMPLES COLLECTED DURING CALENDAR YEAR: 2016
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory.)
FACILITYilt ME°L—I 2 Silfi;lSrervit7e'3Greer}sboro COUNTY Guilford
PERSON,'COUECTN1tG SAMPLE(S) Lawrence'Hurdle PHONE NO. [phone]
CERTiF,1i=D B©RAi'ORj((S) TeftAhieFicd Nashville lbb: 490
PLEASE REMEMBER TO SIGN ON THE REVERSE -i
Part A: Stormwater Benchmarks and Monitoring Results
For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within
30 days of the end of that period to comply with permit reporting requirements.
.Outfall -
No:
.
-Date' `° `".
Sample Collected,
mo%dd%year"
`Rainfall-
inches,'
064d
` pH,
,S_tanda`td
Uriits
0053d
',Total'Sus ended
P
"Solids
SoI!rrig/L`
Non-"`olar
p
'O&G/TPH` ,
MetFiod 1
(, " 664 :"_
SGT -HEM), mg/_L
770Z3x
-Ethylene Glycol,`
J'
g�� F
„8,000 ""
(Tiets 2 and 3)
Below Reporting Limit
(<25)
L"ead, Total= sz
Recoverable;
mg/L
.
78141, "
Total Toxic
'0-anics3
mg/L
Benchmark,.:
Outfall 001
02/16/2016
1.07
9.01"
7.43
100%50
230
15,
Below Reporting
Limit (<4.5)
0.03'
e
J.0
0.010
Exempt
Note: If you report
a sampled value in
excess of the
benchmark value.
or outside the hanrhmnr4
ronno f, ..
.... _ _.
,Permit.
u„6- NA YOU �USL Implement i ier 1 or i ier z responses in the General
1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on-site or local rain gauge (or local precipitation data) must be documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
ZSee General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
Form SWU-251, last revised October 25, 2012
Page 1 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
3 ivwrvI i UKINU KEPORT
For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
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 signithe;following certification statement:
Shcvent,'IVVllzanagemenf'• Plan-,rertification,,S',tatement
i
?'' ,�i'"Based'upon my inquiry of the,person'or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic
orga
4- 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 orics (TTO), I
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the solvent
management plan included in the Stormwater Pollution Prevention Plan."
Lftaeoue N-jI-OLc
Name (Print name)
Title �ttitl`
Signature
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
/2oIIf.
Date
"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.
am aware th t there are s/�_ ignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
412-0h(0
(Signature of Permittee or Designee)
(Date)
Form SW U-251, last revised October 25, 2012
Page 2 of 2