NCG060310 DMR SW (6)

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STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
GENERAL PERMIT NO,NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: .'l0"./3'
CERTIFICATE OF COVERAGE NO,lt 0 Villh (This monitoring report is due at the Division no later than 30 days from
the date th facility receives the sampling osults rom the laboratory.)
FACILITY NAME 6�//9fi4�`-j A/ Axl �� /X1 _ IV COUNTY �/�'!�`W
PERSON COLLECTING SAMPLES /al/0ZL - N ��ti/ _ PHONE NO.W/O) �r9✓
CERTI_I(ILD LABORATORY i�// ' // ?71 Lab# AUG �i 7 2x9 1
Lab# PLEASE SIGN ON THE REVERSE 4
CENTRAL FILE
Part A: Specific Monitoring Requirements DWR SECTION
Outfall Date 00530 00400 00340 00556 31616
No, Sample Total Suspended pH, Chemical Oxygen Oil and Grease, Fecal Coliform,
Collected, Solids, Standard units Demand, mg/L Colonies per 100 ml
mo/dd/yr mg/L
• Benchmark - ' 100 Within 6.0—9.0 120 30 1000
��► - At, 5 0
Note: If you report a sampled value in excess of the benchmark v e,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 _LTV(
(If yes,complete Part B)
Part B;Vehicle Maintenance Activity Monitoring Requirements
Outfall Date 00556 00530 00400
No, Sample Collected, Oil and Grease, Total Suspended Solids, pH, New Motor Oil Usage,
_ mo/dd/yr mg/L mg/L Standard units Annual average gal/mo
Benchmark - 30 100 - 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 7rt-3 (first event sampled) ,, -i, 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);
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"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."
. . /-7. - - 5/ 5/i5
(Signature of Permittee) (Date)
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