NCG060185 DMR SW (13)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO.1�_tvtl_
FACILITY NAME LA) -!/A4, Fo.t r►S I -CC
PERSON COLLECTING SAMPLES 7:S es-e.m! j A n W 1; „
CERTIFIED LABORATORY Aa-1yi,,.r-1 Lab # _3 '1_,731r
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
PHONE NO. S e -!r 941
RECEIV EASE SIGN ON THE REVERSE 4
MAR 2 4 2016
Outfall • D'ate ,'
N'o. P
S'am„!,;•:TotaPSuspendgd'a;i`'
C411.iated', ,,
mo7dd/ "r ',,y
Benchmark'9'.0
0053Q1, ;,I.
Soli' fr ''''•I,r
• d,; ' _ .,,
,;1: "1'' '''':” ,m• jr,� ,, ';r;.,,,
;, ,; ,a;, 0'0400
' ;,
;; r;!;,I' "''
Staiid'ard' units
,i;;,;'''! i„a,'III;;,:I
VVtthin,,.6'' 0 - ,
'Ch mi
s I•„�
!' y'' '',I;;!,„
, , ' :120' r
o
,
.;, ,,, , • ,•,00'S5 I ;1. ' .r.. 1, ;, 3'1616
1, -,
andGrease� ; ,,;i;• -Fecal
,11�' Coliform,,
rm,.
m. ',Colo >iril
'I!!;i' ,, on per 100
„
; !;,,, • ',•,, ,13
< t
Notes If ou t 1 d I
NntP• Tf vnn rAn f o oo., .,10A .. l,.e
_ ._._. __ , -- . 11...,. ...,1., -A- �Uw00 U1 u1c U011G1U11a1K ValUe, ur ouislue me oencnmaric range ror pH, you must implement Tier 1 or Tier 2 responses.
See General Permit text.
Did this facility perform Vehicle Maintenance Aotivities using more than 55 gallons of new motor oil per month? _ yes no
(if yes, complete Part B) —
Part B: Vehicle Maintenance Activi onitoring Re uirements
Outfall Date' : 00556
No: Sample Collected, „Oil an&Grease,,,
mo/d'd/' r'' 1m, �.'
Benchmark I
00530 I, . 00.400 r.
Total suspended Solid's : -', II
.0, '' p �. New Motor Oil Usage,
m' iL Sthn':hrd',.uuits Anniuil"averse aVmo
100' 1; _;, 610,-,9.0',`x' 1-,•
Notes If ou t 1 d I
y repor a samp a va ue m 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 Z -43-1(first event sampled)
Total Event Precipitation (inches): , %0
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
c1urT Inn In,)in-,

"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 pny 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 rmittee) I ILL
0/
(Date)
SWU-249-102107
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