NCS000130_DMR_20210915

STORIYIWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG120000 SAMPLES COLLECTED DU4)NG CALENDAR YEAR: '
CERTIFICATE OF COVERAGE NO. NCG12 (This monitoring report is due t the Division no later than 30 days from the date
the facility receives the sam in •esmlts from t laboratory.)
FACILITY NAME L COUNTY \ ^
PERSON COLLECTING SAMPL k S�\� PHONE NO. )
CERTIFIED LABORATORY �9%vk, �, s �<Lah# \ lr,,
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements
Oiitfap. Dote 00340 :.31616
No Sample Collected, :.' Clieoucal Oxygen DgrAieq l, Fecal Coliform , Total tispepded Solids
mo/dd/ i• . m e. # er 100 m1 m 2
Benclmiark 1000.colohies77 100
n
Note- If you report a sampled value in excess of the benchmark value, you must implement Tier I 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? _ yes \�-no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitorine Reouirements
ONtlryll
No,
Date
Sample Collected,
tno/dd/ r :
00556'.
00530: :::
00400
Oil anti Grease,
nt H
Tot;ll Suspended Solids,,
ru /L
pH,;
Standtird trails
New Motor Oil Usage,
Av ra e.annual aVmo
Band'' ark
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 impl',emenl Tier I or Tier 2 t
occ uenerat rermm text.
STORM EVENT CHARACTERISTICS:
Dat`�(first event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
SLP 7, 4 2021
esponses.
I
Mail Oylginal and one copy to:
Attn: D Q Central Files
NCDE DWQ
1617 R�'iil Service Center
Raleigh; NC 27699-1617
SWU-248-102107
Page I of 2

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