NCG140117 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. D . C SAMPLE COLLECTION YEAR: )DI yi
FACILITY NAME: au- �, m, 6,-I,!iJf. —hirl(D 4Gc 1(61 SAMPLING PERIOD: ❑July-December [l January-June
PERSON COLLECTING SAMPLESAttQo f(V1- LOW) COUNTY 6v(,Il
CERTIFIED LABORATORY uYG IV Tech JAbc Hie, Lab# 5 0 PHONE NO. ( ?MI' 15 —()5025'
_Lab# ADD TO LISTSERVE? OYES I 1NO `MAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: I ISA HQW I IPNA Trout I JOther
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2
Collected pH TSS Event Total
Outfall No. (Standard Duration Rainfall' Monthly #of Months in Tier
(mo/dd/yr OR (mg/L) Monitoring? 2 Sampling2
NO FLOW)1 Units) (minutes) (in)
(Yin)
6 92 1002.3 -
-
I S-020- 11,0 7 . 05 Cd,S 3Re0 t2.1 1 "/p NIR
RECEIVED
x 0 2`Iib
JUN
CENTRAL FI'_ES
uNIGEtTiON
If"NO FLOW"or"NO DISCHARGE, Enter"NO FLOW"or"NO DISCHARGE"for each outfall here Please make sure to mark the sample period above
2 If a value is in excess of the benchmark,or outside the be.lchmark range (for pH),you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 TSS benchmark values are 100 mg/I,except when discharging to ORW, HQW,Trout, and PNA waters where they are 50 mg/I
°For each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge
Permit Date 7/1/2011-60/30/2016 Last Revised 7/13/1]

i
Part B Veh.,ie Maintenance Activity Monitoring Requirements for facilities using>5z) gal of new motor oil/month—averaged over a calendar year __
In Tier 2
pH TPH using method Total Suspended Event Total New Motor Oil ti of Months
Outfall Date Samplea Monthly
(Standard 1664A SGT-HEM Solids Duration Rainfall Usage in Tier 2
No. Collected Units) (rng/L) (mg/L) (minutes) (in) (gal/month) Monitoring? Samplingz
(mo/dd/yr) (Y/n)
6-92 152 1002,3 - -
- -
/V Di- 1) ekW-ei - /1ILS 1i-(4^4t
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL(INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES El NO[� /
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports)within 30 days of receipt of sample (or at end of monitoring period
in case of"No Flow")to:
Division of Water Quality
Attn• DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION 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 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 - re that there e significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
�A 1, APA^-2 L0- 1- 1 (P
(Signat -e of Permittee) (Date)
1
Pern n Date 7/1/2011-60/30/2016 Last Revised 7/13/11
Page 2 of

tatfircarEcH LABSInc.
POST OFFICE BOX 1056 #5 PINEWOOD PLAZA DR.
GRANITE FALLS,NORTH CAROLINA 28630
[phone]
SAMPLE: Loven -Pineola COLLECTION DATE: 5/20/2016
PERMIT#: COLLECTION TIME. 18:15
ADDRESS: Loven Ready Mix RECEIVED DATE: 5/23/2016
P.O. Box 155 RECEIVED TIME: 12:26
Pineola, NC 28662
REPORTED: 5/26/2016
ANALYSIS
ANALYSIS EFFLUENT UNITS DATE ANALYST
TSS <2 5 mg/L 5/24/16 jrg
LOG ID: 1605-354 REPORTED BY: NC CERTIFIED LAB#50
fer4S •
Tony Gragg,Lab Supervisor