NCG060186 DMR SW (14)

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO.(16_�
FACILITY NAME W t- Farm
PERSON COLLECTING SAM LES
CERTIFIED LABORATORY w Lab # 3 7 7381
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR:
(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 _5_r r y
PHONE NO. (33(0 )) -3 587„ 7
PLEASE SIGN ON THE REVERSE 4
Outfall " Date
.
,0 40053Q 0
:,;;
;•,. _,,
N'o. :' ,,; S;ainpl� u r
' °�� � ��
,';, Total' $uspend�d' ; ri'.,'
�'� , ,,, .
ii,; , , - ' ; pH, .
;:• ���'�`' - � �,
Cliondch1,0 en
x3'$.
O,il',and reag6f ; ,ai.'
� ���� • �=Fecal'Coliform, .
- . Cpllected'' r ',
-" Solidi
aiidard" units
,,, • ,
;IS'eii�ati�
,G ,,
„m ;g; ,,, "
'! g' , Coloiiies per;1Q0 aril
' mo7ild/ 'r i
;
[
,
Benchmark' ,
;.,r 1 ;u••
:Wxthiii,..6'0 — 9.0'
' 120'x.100
�'• 0
I
i
o owl
0'a
poi
l.i_4_. rr-----
ivuM: a YOU rcpon 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 Perrmt text.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv onitoring Require ents
no
Outfall Date'
No: Sample Collected;
r'
OOS56
Oil sindAGrease; ,..
M'
00530
;Total Susp'6nded Solids, _ pH; i : ' New Motor Oil Usage,
m" /L Standard,iinits Annitail'avera a al/mo
Benchmark
,30.' i
100: a' ,,. - 6,0.—•9.0' : r ' _
rr,.._. rr_--
i'lULo. a YOU. report a sampled varve in 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
cXxnr')nn ingin�l

"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 lny 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."
•—� a�
(Signature of Permittee) (Date
SWU-249-102107
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