NCG020096 DMR SW (2)

i
DMR - STORMWA'
�.;. SEND TO CENTRAL OFFICE*
'STORMWATER DISCHARGE OUTFALLS (SDO).
GENERAL PERMIT NO. NCG020000
Report ALL S7'ORMWA7ER Monitoring Data on this form (includingft Flow and No Disclfarge_,and>Permi[ Limit Ilrolations):by MARCH I of each year.
CERTIFICATE OF COVERAGE NO. NCG020096 SAMPLE COLLECTION YEAR: 2015
FACILITY NAME: Salem Stone Quarry COUNTY: Forsyth
PERSON COLLECTING SAMPLES: David Thorne PHONE NO. 336-769-3803
CERTIFIED LABORATORY: PACE ANALYTICAL: Lab #12 ADD TO LISTERVE? YES NO D EMAIL:
Part A - Stnrmwater Mnnitnri— Q -i,-+,
Outfall
No.
Date Sample
Collected .
(mo/dd/yr OR
NO FLOW)t
In Tier 2
Monthly .
Monitoring?.
/n
# of Months in Total Flow
Tier 2 (MG)
Samplings
Total Suspended
Solids
.(mW')
Turbidity°
(NTU)
Settleable
Solids (ml/1)..
Total Event
Rainfall Duration
(in)
-
- -
1003'°
See.Footnote3A
0.1
Jan. -Jun. Riser Basin #30
Jul. -Dec. Riser Basin #30
No Discharge
12/18/15
30.7
18
.3
ND
No Discharge
1.5 12
If "NO Ft nw" nr ^Tin nicr LJ A V 1 T7
------ - - - - -- .. -- . • --... ..vu av, w..,, vuuau „cw auu UIV Lata Rai'gu.
3Per NCG02: Tier 2 Monthly Sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
44 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Teir 1 or Tier 2 responses in the General Permit.
TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50.mg/l.
SThe discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservois designated
as trout waters; 25 NTU for all lakes and reservois, and all salt water; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/1/2010-12/31/A14
Last Revised 01-21-11
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Part A: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor nil/mnnth nn avrraup
Outfall
No.
Date Sample
Collected
(mo/dd/yr-OR
NO FLOW)'
- -
In.Tier'2
Monthly. # of Months in
Monitoring? Tier 2..
(y/n) Sam plingZ
New Motor
Oi1.Usage
(gal/month) `
-
--- -' ---a-
Total Flow TPHusing .method
(MG) 1664A SGT -HEM
- '(mg%1)
-15 s
Total Suspended
Solids
(mg/1)
160,
Event
pH ERainfall
(StandardDuration
Units)
6-9
Jan. -Jun. Comin led Water
25.0
Jul. -Dec. Comingled Water
25.0
LEE
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NOe—
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT'
VIOLATIONS) BY MARCH l OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICA TION FOR ANY INFORMA TION 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 sumbitted: 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 imprisionment for knowing
(Signature ermit
Permit Dat . 1/l/2010- /31/2014
(Date)
1/6/2016
Last Revised 0 1 -21 -11
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