NCG060129 DMR SW

Pi
04r
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO.NCG1106 012
FACILITY NAME Fre : e, e-4 FO o d f DC
PERSON COLLECTING SA LES Illl
CERTIFIED LABORATORY esn��(. ,f' lac. / LaL Lab # 3(/
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: r
(This monitoring report is due at the Division no later than 30 days from
the date the facility receivesth ampling results from the laboratory.)
COUNTY a 1296
PHONE NO. (7aj�J K 36 PC 2.1
PLEASE SIGN ON THE REVERSE ->
Outfall
No.
Date
Sample
Collected,
mo/dd/ r
00530
Total Suspended
Solids,
00400
pH,
Standard units
00340
Chemical Oxygen
Demand,
00556
31616
Oil and Grease,
mg/L
Fecal Coliform,
Colonies per 100 ml
Benchmark
-
100
Within 6.0 - 9.0
120
30
1000
- l -D f
1 01/2 3/i �- I
71f..i
I ill
5 4
Y
9 0
r 0
As
7
sa'
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 Xto
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity onitoring Requirements
Outfall
No.
Date 00556 00530 00400
Sample Collected, Oil and Grease, Total Suspended Solids, pH, New Motor Oil Usage,
mo/dd/ r m Standard units Annual average al/mo
Benchmark
- 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 CHARACTERISTICS:
Date / Z S f' (first event sampled)
Total Event Precipitation (inches): • S
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Mail Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RECEIVED
MAR 12 2015
CENTRAL FILES
DWR SECTION
SWU-249-102107
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"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."
(Signature of Permittee) (Date)
SWU-249-102107
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