NCG080863 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCGO80000 SAMPLES COLLECTED DURING CALENDAR YEAR: Qo �S
CERTIFICATE OF COVERAGE NO. NCf_C, ' � (This monitoring report is due at the Division no later than 30 days from
_ t ;et�i�c ity receives the sa�mInpling results from the laboratory.)
FACILITY NAME J� c.
r�r1'� C a c� c rh v `L L COUNTY uo r'l>a tr,
PERSON COLLECTING SAMPLES PHONENO.1 lc1
CERTIFIED LABORATORY Er\,LO �--� boc-a� Lab # SEP 48.201`
Lab # PLEASE SIGN ON THE REVERSE 4
CENTRAL FILES
Part A: Vehicle Maintenance Areas Monitoring Requirements DWR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?c yes _no
(if yes, report your analytical results in the table immediately below)
Outfall Date
No. Sample Collected,
mo/dd/ r
00530
Total Suspended Solids,
m
00400
pH,
Standard units
00556
OR and Grease, New Motor Oil Usage,
Annual average al/mo
Benchmark -
100
Within 6.0 — 9.0
30 -
�
6.0-9.0
r
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.
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall
No.
Date
Sample Collected,
mo/dd/ r
00556
Oil and Grease,
00530
Total Suspended Solids,
00400
pH,
Standard units
Permit Limit
-
30
100
6.0-9.0
r
STORM EVENT CHARACTERISTICS:
Date a ' (first event sampled)
Total E en 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 Nail Service Center
Raleigh, North Carolina 27699-1617
SWU-250-102107
Page 1 of 2

C
"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. I am aware that there are significant penalties for submitting false information, including
the possibility of fines and imprisonment for knowing violations."
ri C\(- css q IS'
(Signature of Per ttee) (Date)
SWU-250-102107
Page 2 of 2