NCG190018 DMR SW (13)

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG190000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE (COC) NO.: NCG19 t7E- 00®
FACILITY NAME: y- W H sit _,s, IN,•
SAMPLE COLLECTION NAN[E: OP_r,gEF_-, F. KA -f -D x!
CERTIFIED LABORATORY: ik- Lab # iO
Lab #
Part A • Cnnrifir Mnnitnrina Remiirements
SAMPLE COLLECTION CALENDAR YEAR:�%1 c�
(This monitoring report is due at the Division no later than 30 days from
tle the ility receives the sampling results from the laboratory.)
SAN �FAC,IiIT
�
LITY COUNTY:
PHONE NO.: ()
CEINI T RAL FILES
Outfall
No.
Sample
Collection Date,
mo/dd/ r
Total Rainfall,
inches
00530
TPH by method
1664 (SGT -HEM)
U V V ` 111.9,; 1101
i 01104
01094
01114
Total Suspended
Solids, mg/L
Non -Polar Oil &
Grease, mg/L
Copper 2,3, mg/L
Aluminum2, mg/L
Zinc2'3, mg/L
Lead' 3, mg/L
Freshwater
(Saltwater)
Benchmarks
-
-
100
15
0.010
(0.005)
0.75
0.126
(0.095)
0.075
(0.220)
�- -
6). 3C"
4—
6.0)0
DCS
3 yo
CoJ
- `�
Z_
0. 0I
�0
C). I
C1o_
' If a value is in excess 40he benchmark, you must implement the Tier 1 or Tier 2 responses in the General Permit
` Total recoverable -metal.
3 These benchmarks are'�water hardness dependant Values shown based on a hardness of 50 mg/L
i, Solvent Management Plan Certification:
Mail original and'one copy to: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
Division of Water �Resouices managing solvents, I certify that to the best of my knowledge and belief, no leak, spill, or dumping of concentrated solvents
Attn Central Files into the stormwater or onto areas which are exposed to rainfall or stormwater runoff has occurred since filing the last discharge
1617 Mail Seryice Center monitoring report I further certify that this facility is implementing all the provisions of the Solvent Management Plan
Raleigh, Noith Carolina 27699-1617 included in the Stormwater Pollution Prevention Plan "
1, aCj
(Sig re of Permittee) (Date)
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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."
f
(Signatu q of Permittee) (Date)
Permit DaV 6/02/2015-5/31/2020 SWU-253-060515
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