NCG120060 DMR SW (3)

STORMWA'TER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
GENERAL PERMIT NO.NCG120000
12 SAMPLES COLLECTED DURING CALENDAR YEAR: -7
CERTIFICATE OF COVERAGE NO. L– D/
(
/ (This monitoring report is due at the Division no later than 30 days from the date
I the facility receives the samphn results from the laboratory.)
FACILITI`NAME i fit./(5
PERSON COLLECTING SAMP . 'S Jas a y°J •
/44,4//COUNTY
CERTIFIED LABORATORY s PHONE NO. s_J
Q e !/ a Lab# Com) 7S 7 Q4 6, ri
• #a— PLEASE SIGN ON THE REVERSE 9
Part A: Specific Monitoring Requirements
Outfall Date 00340
No. Sample Collected, Chemical Oxygen Demand, 31616 00530 E
mo/dd/ r Fecal e 1 Dorm, Total Suspended Solids,
AUG�G
l3enchm•rk m # ler 100 nil Z(J��
m_ L
QU m , - 28–/ 120 1000 colonies 100 CEt�+Ttigd
1 / • DV VR SEDT`Olti
Note. If you report a sampled value in excess of the benchmark value,you must implement Tier 1 or Tier 2 responses. See General Permit text.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ees no
(if yes,complete Part B)
Part B: Vehicle Maintenance Activit Monitorin Ref uirements
Outfall Date 00556
00530 00400
No. Sample Collected, Oil and Grease, ` Total Suspended Solids,
mo/dd/ r m_/L pH, New Motor Oil Usage,
Benchmark m- Standard units Avera_e annual _ai/mo
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 res onses.
See General Permit text.
p
STORM EVENT CI CTERISTICS:
Date l G(Frst event sampled)
Total ve t Precipitation(inches):- ® Z Mail Original and one copy to:
Attn: DWQ Central Files
NCDENR/DWQ
Date (list each additional event sampled this re porting 1617 Mail Service Center
(inches): _ P g period,and rainfall amount) Raleigh,NC 27699-1617
Total Event Precipitation(inc
SWU-248-102107

STORMWATER Dnp. TARGE OUTFALL(SDO)
MONITORING REPORT
"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."
a(Ad i, /
(Signature of Permittee) (Date)
SWI I-248-102107
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