NCG030556 DMR SW (3)

STORMWATER DISCHARGE OUTFALL(SDO)
hcMONITORING REPORT
� � SAMPLES COLLECTED DURING CALENDAR YEAR: oZO IS
GENERAL PERMIT NO.NCG030000 ,�• ''"� `'��
CERTIFICATE OF COVERAGE NO.NCG03'C)300Q I (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 Ante burr SCOUNTY 1MeC`L,Nyv‘Ira4.) ,
PERSON COLLECTING SAMPLES RECEivEDPHONE NO.(70U ) 3giq- LISA\
CERTIFIED LABORATORY%Ce, pYla4- ; ,® Lab#
Lab# DEC 282015 PLEASE SIGN ON THE REVERSE-->
Part A:Specific Monitoring Requirements CENTRAL FILES
�. 1__!, ,�'�«zc 2i;';;.',:�,�"78a14,1=:--�
tfall • Date` ,,�"` .x3,,..00530;:"
;, - ;, i°Lead,kn Oil and�Grease;' :To'ta1;;Tonc`.Organics1,:
otril Sus"'
Sam le_C�II�c'ted�-,•„T_ � erided ,>; , . >F., ;z�,• ,,,,,,,,. ,•r,. ;,i;,::y„ •,,;,-�„ • ,.�•,i., , ,,
s, ;,.;,, ;Within 6:0�7 `� s;a .P; :`:0 033: ,,,•,:,:�, _`,:;.. 30- -
•Benehmark • r- , �p0,';:'. '= 0 ';
A 1 i► '3o I u', 1 ays o\i (fi. YU 6 Nb 11
0Z 1111011s- Lig nnt1L 69.3 b IV
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 Total'Sux:s00e5d3d0e;;,d ii'Sa`.`l•i:d:,s.;,':;,' „
New"M'otoi~OilUsage� .
,}: Ne •y r,:
_ . - Samlie��ollect+ed`s:i�. ��:;;�; --0 ,rtndG � :,;;; - :�.-�.P sc�•�,;;.,.,,;-�,;,�.. ",• _ - _.�.; a -a mo.
'No P_ �,A. - ,.j,,: ;,Standard snits ,:-Anndal,averag g 11
Benchmark
30 ,''>�OO.;,, r.-,. ,.r •• °� , ,.;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 11130115-(first event sampled) Attn:DWQ Central Files
Total Event Precipitation(inches): P'20 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):
SWU-245-102107
® Page 1 of 2

•
1 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations,manufacture semiconductors,manufacture electronic crystals,or
manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA Effluent Guidelines for the facility subject
to the requirement to sample(for metal finishing use the definition as found in 40 CFR 433.11;for semiconductor manufacture use the definition as found in 40 CFR 469.12;for
electronic crystal manufacture use the definition as found in 40 CFR 469.22;and for cathode ray tube manufacture use the definition found in 40 CFR 469.31).
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For those facilities allowed such a waiver,the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics(TTO),I
certify that to the best of my knowledge and belief,no dumping of concentrated toxic,organics into the stormwater or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management
plan included in the Stormwater Pollution Prevention Plan."
6Aa . tAetsnk_.5
Name(Print name) -
MiC A-I-ance
Title(Print title)
Jz/z3 )Lc
(Sign t e)
(Date)
•
"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."
12/23 ) 13
(Sig irlY re of Permittee) (Date)
SWUJ-745-1 n71 n7