NCG060307 DMR SW

STORMWATE!" DISCHARGE OUTFALL.(SDO)
MONITORING REPORT
GENERAL PERMIT NO.NCG060000SAMPLES COLLECTED DURING CALENDAR YEA!':: 2-6/y
CERTIFICATE OF COVERAGE NO.176761 b /-2xo 1 (This monitoring report is due at the Division no later than 30 days from
7L .7---.7,17//,, dtiA/C..._ the date the facility receives the sampling results from the laboratory,)
FACIDC,IT�'NAME Q�,.f�' i tCOUNTY Gal c.' o.
ECEIED
PERSON COLLECTING SAMPLES ("._ ;,--e e �w,��;;Bosh/._c 7e - PEIONE NO.( 91 y ) z/G'7-3 0 9 o (E,V )
CERTIFIED LA r:ORATO r:Y EA/CO L-Akr Lab# (Li/0 39 V 'J
Lab# PLEASE SIGN ON THE REVERSE 4
Part A:Specific Monitoring Requirements JAN 21 2015
OutfallCENTRAL FILES Date 00530 00400 0034000556 31616 DVIR SECTION
No., " Sariple- ' Total Suspended pH, , ' Chemical Oxygen-- Oil and Grease, Fecal Coliform,
Collected, - Solids, Standard.units - Demand, mg/L" Colonies per 100 ml
mo/dd/,yr m• , - m_, ,
Benchmark .. 100 Within 6.0-9.0 - 120 30 1000
3 12j'301y LI-y 6-3 t 1O . L
Z 12/3 1K :3-1; s ./ r'( 2-� LI
.3 E1 3o /V A• Y G- a to U s:3 z.
Note:If you report a sa pled 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 00400
' No., Sample Collected, - Oil and Grease, ,Total Suspended Solids, pH, New Motor Oil Usage,
mo/dd/,yr ing/L mg/L Standard-units Annual average gal/mo
enchmark - _ 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 responses.
See General Permit text.
STORM EVENT CHARACTE i':i STICS: Mail 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):
SWU-249-102107
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"I certify,under penalty of Raw,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. I:ased 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 a, i! imprisonment for knowing violations."
r� �i'il/1-'
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i'i e of l e r�l I I!in)
(Date)
SWU-249-102107
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