NCG080773 DMR SW (2)

STORMWATER DISI -i. :GE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG08000 ,
CERTIFICATE OF COVERAGE NO 4NCGO8
x
FACILITY NAME - 0 1 j
PERSON COLLECTING SAMPLES ; a _
CERTIFIED LABORATORY Lab #
Lab #
SAMPLES COLLECTED DURING CALENDAR YEAR: t' _
(This monitoring report is due at the Division no later than 30 days from
the date the'facility receives t e pling' esults f om the laboratory.)
COUNTY c.! 1
PHONE NO. L �/ `ter% (r7
PLEASE SIGN ON THE REVERSE 4
Part A: Vehicle Maintenance Areas M hitoring Requirements
Did this facility perform Vehicle Mainte `nce Activities using more than 53 gallons of new motor oil per month? _yes no
(if yes, report your analytical results in th ; table immediately below)
Note: If you report a sampled value in exIss 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 Secoidar
y Containment Areas at Petroleum Bulk Stations
�,.'. J14`tfn�dffll'ill{G�I� �_ ,.•� ra,l5�i t.�'ILdtOhlW'v �y :n��„�!„�nuNd sea,�rr, ; i rand Terminals
STORM EVENT CHARACTERISTIC!:
Mail Original and one copy to:
DateDivision of Water Quality
Total ve►it Precipitation (inch s):
(first event led) Attn: DWQ Central Files
nc�r
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Date (list each additio al event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inch s):
EEIVFD
AUG 13 209.5
CENTRAL FILES
DWR SECTION
SWU-250-102107
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"I certify, under penalty of law, that this document and all attachments were prepared under my
supervision in accordance with a system designed to assure that qualified personnel properly gatb
information submitted. Based on my inquiry of-the person or persons who manage the system, or
directly responsible for gathering the information, the information submitted is, to the best of my
true, accurate, and complete. I am aware that -there are significant penalties for submitting false i
the possibility ine and imprisonment for knowing violations."
(Signature of Permittee)
(Dat)
ecrnon or
and evaluate the
ase persons
owledge and belief,
Prmation, including
SWU-250-102107
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