NCG060185 DMR SW (19)

STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
GENERAL PERMIT NO.NCG060000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE 01?COVERAGE NO.NG3
6' ►-- (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 tae ,le. LL c- COUNTY g D gam, COUNTY furry
P
PERSON COLLECTING SAMPLES jerk,,y ,3®,,,J' /VCE 1 !� PHONE NO. (336.) 3$62 ' Sr6.1
CERTIFIED LABORATORY os-,l: a Lab #
Lab# JUL— 2 9 2016 PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements CENTRAL PILES
l\\IR SFCTI2N
Outfall Date 00530,Kr; ; ;y,,,l' s 00400 „(1.034{1 i,; '? •_.;
Nd. ! ,S'i mp1e' .,i' ,,,,;. {Total'Sus eit ;
did',' rir';,, 11 GliGmicahOx ' eri ' :'IOiI',ain ise _ Fecgl
_., . - , ;.-,., ,,,:.; •,�;;; ,' - , Coliform
Collected; r. iSohds f ' ' ;o'r';!I; 't'Yt'aa' ii'" a,, �.,;, ;,,j .,., y:,;, m. ! i' ,<«„
", ` !I 'i' _A ti Y„ nllit9 'i • I�-C[t1Hf1C1, �!'-i' •-�, pi►��! 1'J,,"' ' � �oluriies'.]iLr:1Q0 yiil
it •
"I' �'tn ��,•;,�. IL•• �'�,,�
Tien lust' , . ,, `, �'''' i'P� '.i r •� �;,�iig1A',; �,i^,�, �, '��.,'' I , '�. ,.
c ark'• ', ''L04.; .: !; r, l' Wi�tlti�i,6 0-9'•0': G` ,' ;'i,,,,, "
5 Co- Po/(? /IO Poi,/
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 Data' 00556 00530 .
e O1A00<;iNo: Sal (e Colleeted, „,Oil and.Greasi. , Total Suspnded
iN. Neiv Motor Oil Usag
,•mo/dd/ r t frirt /I= , •Anlitii"average
galhno
)ienclunark • ;'.' ; r,,.' 30r' •. '
G' ',�� • ,., • 100'.- r',:l. i, . + .�''.,'-� �6;0,-�•9i0'�,��'' . - .,, -� '
Note. If you report a sampled value in excess of the benchmark value,or outside the benchmark range for pHI,you must implement Tier 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CHARACTERISTICS: Mall 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):

"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 piy 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."
11 g(e/i6
(Signature of . • mi •e) (Date
S WU-249-102107
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