NCG060186 DMR SW (17)

RECeiVED
JUN 2 2 2016
STORM'WATER DISCHARGE OUTFALL(SD()) CENT
MONITORING REPORT SWR SECTIOES
N
GENERAL PERMIT NO.NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR: 2
CERTIFICATE 01?COVERAGE NO.NCG(16 .0 1f (This monitoring report Is due at the Division no later than 30 days from
lei the date the facility receives the sampling results from the laboratory.)
FACILITY NAME G,Je-ine- rkrols LLL ( roN) COUNTY Surrt/
PERSON COLLECTING SAMPLES ;,., 6,,rk;,b,i.,...— PHONE NO.(336 ) 3g4-5 7
CERTIFIED LABORATORY p1sri.fc Lab # /(oS
Lab# PLEASE SIGN ON THE REVERSE -4
(Part A: Specific Monitoring Requirements
- 1.'••Outfall • , 79'at`e• : • 00530;,h4;, ; a„4,'.,'1' 0'0400 ;',0.0340•.••••,j,;',!;,!, ;,.,,
e' :TotiiP '':i.; n„,„ ,,, , OQ' 4YIa ” ' :, ;, '�'G16
•
. , NO. ' ' r .,,;'S,�mpl t••;I,',•,:,!,,, ttspeud4d.':''' :'ii i' Cl xiii f�1.0 en : ';'4°.#'.#1049611$4"'•.:
! 4wdllected' ;,._ :!' !'1';.r" �,,, ,;,,'' !•. ,r,.< 0, ?6* � Hyl„.:'Feci414''oliforni .
'" �'I >'i I q olid "'' ;u`II,;!i i7�Alidard'unit8 ''' '%'I�Ciha1ii , I•i! '' ,I; mti�!'.1J; ''i J' },,', 01(111'188'' b1.100 ml
'I
MO-Mil/yr ;1::'.11,.:u, '1' ,.ynk0::: „a .�'I Ih,l' I. '95•.I!; i i , ,' .ir h 'i iii;/1l'.',I,,, �1l'I'I,, :'�plbi,,;,'I " i'‘'.!.;,:':::.,.: -' q,'i' ..Y .
Benchmark' - ' 1r pl'^'\JV't �+ ;i,
n r S'. ';:, ;b n':o 46,4���,i.h., ithitt;,p'0'-0'.b „ ;.,., ;,,,'', 20..' �,;r, ,ir,I).!''s':'11-iiid..:,.,; , ,� +' �',r,X00o ,
0
001 s - /7- /6 1 qcf 6 ..5 `7 CoQ 9 -
oo3 S- i7- /to P ? 2 7. 3 (0,070 45
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 . ,; •,?L. ''00400'..1„: .r, .
' No: ' Sample Collected, '..Oil and•Grease,,, - Total Susp'end'ed Solidi H '' .I '
mo/d'd!y „ , !t ''' ` New Motor Oil YJsuge,
Benchmark .- r rig/lt, -mg's ` t Stan'tlitrd'iiii,i•ts •, Ani till average gal/tno .
1 n rk , ;,.':r, ;w ;,,,301' ,:l •. _
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,"-(?-r6 (first event sampled) Attn:DWQ Central Files
Total Event Precipitation(inches): . /5 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):
C'U rT T n,n 1 n n r n-
.

"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 fins and imprisonment for knowing violations."
- c-t 6 /`
O Ili
(Signature of Permittee) (Dat�
•
S WU-249-102107
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