NCG190028 DMR SW (4)

STORMWATER DISC i AGE OUTFALL(SDO)
GENERAL PERMIT NO.NCG190000
DISCHARGE MONITORING REPORT(DMR)
CERTIFICATE OF COVERAGE NO. 1J,-0,1 Za. SAMPLES Wv14,ECTED DURING CALENDAR YEAR: 2016
)• y i report is due at the Division no later than 30 days from
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RAI; c,., =-the facility receives the sampling results from the laboratory.)
FACILITY NAME DUCK CREEK SMALL BOAT HARBOR2i 'Lilo COUNTY CRAVEN �8
PERSON COLLECTING SAMPLES Jim Frei/SwSG 30\- PHONE NO. [phone] E v D
CERTIFIED LABORATORY Pace Analytical Lab# 12/40/67 EXTRA!-FILES I'
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SwSG Lab# 5054 '-SWR SECTIO ��� 2:I-CF::
016Part A: Specific Monitoring RequirementsFNTRLESOutfall Date 00530 00400 00556 01119 01104 0109401114OWR S1O�
No. Sample Total Total pH Oil& Copper2'3 Aluminum2 Zinc2'3 Lead2,3
Collected Rainfall Suspended Standard units Grease mg/L mg/L mg/L mg/L
mo/dd/yr inches Solids,mg/L mg/L
Benchmark' - - 100 Within 6.0—9.0 15 0.005 0.75 0.095 0.220
001 05/29/16 0.53" 28.4 6.92 < 5.0 0.0251 0.18 0.106 < 0 0050
002 Represented by SDO-001
`If a value is in excess of the benchmark, or outside the benchmark range(for pH),you must implement the Tier 1 or Tier 2 responses in the General Permit.
2 Total recoverable.
3 These benchmarks are water hardness dependant. Values shown based on a hardness of 50 mg/L.
Solvent Management Plan Certification:
Mail original and one copy to: "Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement
Division of Water Resources for managing solvents,I certify that to the best of my knowledge and belief,no leak,spill,or dumping of concentrated
Attn:DWR Central Files solvents into the stormwater or onto areas which are exposed to rainfall or stormwater runoff has occurred since filing the
1617 Mail Service Center last discharge monitoring report. I further certify that this facility is implementing all the provisions of the Solvent
Raleigh,North Carolina 27699-1617 Management Plan included in the ormw ter Pollution Preventio ' .s " ---
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7-a2-I(e
(Signature of Permittee) (Date)
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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
ossibility f fines nd imprisonment fo • �a violations."
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/ 7' ZZ-t l0
(Signature of Permittee) (Date)
Permit Date: 06/02/2015—05/31/2020 SWU-253-92309
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