NCG080773 DMR SW (3)

STORMWATER DISCIi__,.GE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCGO80000
CERTIFICATE OF COVERAGE NO. NC1G08 0 7�
FACILITY NAME � /,� � � �5 to
P�
PERSON COLLECTING SAMPLES Gil
CERTIFIED LABORATORY _ _z,�- Lab #
Lab #
SAMPLES COLLECTED DURING CALENDAR YEAR: /Z/
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling re alts from the laboratory.)
COUNTY Z_
PHONE NO. (qJ
PLEASE SIGN ON THE REVERSE -->
Part A: Vehicle Maintenance Areas Monitoring Requirements
Did this facility perform Vehicle Maintenance Activities using more than 53 gallons of new motor oil per month? _ yes
(if yes, report your analytical results in the table immediately below)
V�cQ 41 E
.IAN 0 g n't,
—j— . P. LL a aauiPieu vaiuc u,i excess or me oencnmarx 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 Seaarators and Secandary CantatnmPnt ArPaC at iPatrnI.— n 11, et 4-1 ...a
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STORM EVENT CHARACTERISTICS:
Date 1 /(v q (first event sampled) �.
Total Eve t 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
FILES
'-rION
S WU-250-102107
Pagel of 2

"I certify, under penalty of low, 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."
(Signature of Permittee)
1571-�VAI
ate
Swu-250-102107
Pave 7. of