NCG060185 DMR SW (15)

STORMWATER DISCHARGE OUTFALL(SDO) •
MONITORING REPORT
GENERAL PERMIT NO.NCG060000 _ SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. s tt;06 l4 - (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.)
FACILITY NAME �tJ�_/,, `'� ins C — ,COUNTY �jrc)t r
PERSON COLLECTINGS LES 3c rcr-� �jw�V i`I
RE--CEA/Ea'ONE NO.( ) y�5�/, -5�6
CERTIFIED LABORATORY r e ,�: I� �r_ LLab ab# 3 7 73 SEP 0273
2015 PLEASE SIGN O THE REVERSE -.
Part A: Specific Monitoring Requirements CENTRAL FILES
DWR SECTION
- Outfall , Date 0053Q�;, ;;,:', 'F?e-:., 0Q400 ._ 0034U !; ''',' .,OQ' St �,; ' ' ; , ,. ,L;,31616
No. ,,;S'ample• ; . • ,; .Total Suspended;r!`,'!i; H '•Ch mical'.O en. and. f '
• - • - • - Collected'� • - ' • "• •'• �,�. �1? �, � ,,�, _ �� .011,and.GreaSea ; ,-,a!; 'Fecal Coliform,-
,,,,'; ;;Solidi "' ,;,'�!�,Sta,1dard'units ' • ;,.';"Demand :,,' c9:
• ., .„ mo%d ;J, - ing/L•��;�,� ,:y,�� �•-- 'i�;;7,,,,,, - - ' �•, _ ',.� •'''.,; . • /�,�',' ��� ,},,Colonies per�1Q0 aril
Benchmark' _ ,, , ,• ...
00 y 0.7-- (20/5 ,OCloc-) : xthnG:O•-9. .. ", - , , 20 .. ; ,,i,•,,,
„!'30..,,•, , ! "', .,.', ,,.!,X000- ..
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.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes _no
(if yes,complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
_ Outfall Date 00556-, 00530
No: • Sample Collected; „Oil in&Grease;,, ,Total suspended'Solids AFI, ,New Motor Oil Usage,
'mo/d'd/ I•
Yr: '�•• nig/I,-' .�-. mg/I._ . , ,, _,' Standard:'units . ,_ Annual`average gal/mo .
Benchmark ; ' 30 100' ,k'., 1, ! : _
' � .6,0_.9:0'.. �-„ ,,,
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.
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date (first event sampled) Attn:DWQ Central Files
Total Event Precipitation(inches): 1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Date (list each additional event sampled this reporting period,and rainfall amount)
Total Event Precipitation(inches):
Q1.1/Tr 1,tn 1nn1ni

"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 fmes and imprisonment for knowing violations."
(Signature of Permittee) (Date)
SWU-249-102107
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