NCG060186 DMR SW (12)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO. NCG06��;i�r�
FACILITY NAME W�„�,� rc, r^ 5 L C
PERSON COLLECTING SAMPI ES 3djo,,Ic" --
CERTIFIED LABORATORY pi, /�,,�(�e I Lab #
Lab #
Part A. Specific Monitoring Requirements
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 S JrrV
PHONE NO. aAj g(o - S 86 7
PLEASE SIGN ON THE REVERSE 4C I
Outfall Date
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:. 00556
00490
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_- , 1. . u 0 -..P.UU v1.1110 111 UAL,06`J 111 LUG UGHU111HUM Value, or outsiae the benctimarlc 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
(ifyes, complete Part B) —
Part B: Vehicle Maintenance Activity Mnnitnrina 1RPnnirPm ,Ir
Outfall_
Date'
No. 8atrople C olleeted,
tno/d'd!'�• i,
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:. 00556
00530
00.400 I •
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Total us ended Solids
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41 1
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y ; 'pHr; i,
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New 'oto; Oil Usage,
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.....,. .. .1.... ,.,lay.. u au...l,.. vu.u� ..1 cXGC85 OL L110 U
See General Permit text.
STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inclies):
k value, or oulslae llle benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
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
MAY 2 0 1096
011"T". I--

III certify, under penalty of law, that this document and all attachments were prepared under Illy 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,
trite, accurate, and complete, I am aware that there are significant penalties for submitting false information, including
the possibility of fines and lniprisonment for knowing violations."
(Signature of
:n�
(Dat
S)VU-249-102107
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