NCG060323 DMR SW (4)

F'
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO_ NCG060000 , SAMPLES COLLECTED DURING CALENDAR YEAR: ZO
CERTIFICATE OF COVERAGE NO.� CG06 � (This monitoring report is due at the Division no later than 30 days from
FACILITY NAME
the date the facility receives the sampling results from the laboratory.)
C �` `�✓ x� y
COUNTY
PERSON COLLECTUVG SAMPLES PHONE NO. (gj y) zai –
CERTIFIED LABORATORY Lab #—'
Lab # PLEASE SIGN ON THE REVERSE >
Part A: Specific Monitoring Requirements
Outfall , ` Date
No. S m le ;
.; a p
_mo/ tib/` Y'
Q ;•:. "' ;; ",
", . •,,0053 '
; ;a, ','
, . ;rt- ", OQ400
}, ,00340`
�, . : < r`'..,-�
,, i , ; ,,;0055, '' ,;,,, .,,. ,,;
6'.; ,
, i . s , 3'1616
.Total';Su'spended' r''''
,,•„';; ,;
,, ,�. _
:''lil %],'_'.b.;
ti, ....,,•' r
s ;• : a pH, r
'::„,,',., . ,,..,_�:,Yg
Sfandard�'iiliit
s,.,_,; r'; ,,„=,,�
”? ;i,ip;,.,, i
'Chemikal;0 en
eina d'
! ,.
?m �,�h'S`prJ`• :•i�
OiI ari , rease;
4, ,• `'•;
.a'"r.,,: - _
-� "'.Fec al'Coliorn►,•,
;'Coloriie's'per100'nil
S'1• _
100
Withio".Gt0-9.0'
„120- ;i
i, ,',.. ';;39•�_'r ;'",•
;:;`X'000,
Dote: it 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 Activity onitoring Requirements
0,9
Outfall,
No:
No.
•
Daae.'
^• '' ' -
Sample;Colle'ced,' _
' ICIO�(1(1�' r,l'�,° _
'"' ,,'-''O,OSG'::;, s,rw,l• ; , :, 06.400.',,.:-
0,400;, , :
-; ,.,OiYr,al>d;"areas"e; .Total -Suspended Solids; -u ypIi; _,; 2;, : ;N'e� otos' d -
,• '- ','-2 . y'., , M O" Usage
- _ .y "�' ', *,-� r: rl' . , '
.r. m"%I•,: ''� � � �m°'%L;� �tandard.;un�fs".;.'; ,`'�Ailnual'�avera e'� alllno
Benchmark
:�''''
,, :,; , 30'':,• �„ '`
= 100'': a.' i s'cw - -
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):
4-1*- A
Date (list each additional event sampled this reporting period, and rainfall amount)
"Total Event Precipitation (inches): ,
/r
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617