NCG020775_MONITORING INFO_20180227

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
w a�
YYYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
❑HISTORICAL FILE
DOC DATE
❑
YYYYMMDD

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) - STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year Z6 t-I
`Report ALL STORMWATER monitoring data on this form (include "No Flow"I"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02
Facility Name: A/, /_ 1, rAA COMPWAle 4 f9?L/il
County: o�tel�
Phone Number: ( w ) 676-- 241— Total no. of SDOs monitored
Certified Laboratory f9i6e" Lab # f
Lab #
Stormwater Discharge Outfal! (SDO) No. A VMA Outfall? Yes ❑ No
Is this outfall currently in Tier 2 for any parameter? Yes ❑' No']
Was this outfall ever in Tier 2 during the past year? Yes ❑ No�s
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease fretuency ❑ RECEIVED
Yes, received approval from DEMLR to reduce monitoring frequency ❑ RECEIVED
No, turbidity benchmark exceedances did not require monthly monitoring ❑ FEB 27 .Z4j$
Other ❑
ntnrP CFC.TIION
�t
outfall ..a.
-----
Total
Rainfall,
inches
TSS,
mg/I
SS,
mill .
Turbidity,
NTU
Upstream
(U) Turbidity,
NTI U
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mg/1
(VMA)
New
Motor Oil
Usage
allmo.)
Benchmarks
Indicate NO
FLOSS
ilcaide
CirclStormwater "hm
A hmarM
1 I.riO
Q•�
Circle
ctunark
5 2B'e/
NIA
Quality
Standard applies
NIA
Standard appWater
lies
1 `�
>65e requires
average requires
and Non -polar
TO&G monitoring
Date Sample
Collected,
molddl r
-
a /7
No A24V—
—
Permit Date 1Oil /2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑o ©❑ b�
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No., VMA Outfall? Yes[-], -,No
Is this outfall currently i.n Tier 2 for any parameter? Yes ❑ , No 0
Was this outfall ever in Tier 2 during the past year? Yes ❑ No ® •
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?.•:
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring _-- .., ❑
Other ❑
Outfall No.
Total;TSS;
Rainfall,
inches'
.•
mgll,:
` SS;.
.mUI
'Turbidity,
t
NTU
Upstream'
(U) Turbidity;
NTU
Downstream
'(D) Turbidity,
- p. "NTU`
` '
Non -polar
�O&G, mgll
(VMA)
New ,
Motor 0if '
,p.Usage .
allmo.
Stormwater
Mdka[e NO
FLOBenchmarks appl bre
curia
ark
1 QO Q
0.1
Circle
chmark
50 5I10
NIA
5 ndard applies
NIA
Standard applies
15
gaumu-
average requires
TSS and08G mo rlt do ar
Date Sam pie
Collected,
rnolddlyr
. t6
Permit Date 10/1/2015 - 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ®©©&
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No Z.
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No
Was this outfall ever in Tier 2 during the past year? Yes ❑ No 0
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑
:Outfall`No
x,
Total'.
Rainfall,
inches
TSS,
mg11
t„
Taos..-
t SS, _.
mlll
.' j -i„ 't:!
Turbidity,
-
NTU
• x� '�%-n yj._ ..
- Upstream'
'(U) Turbidi : ,
ty
=NTUrmil
T
Downstream
{D)'Tuebidity;
_
F j k
'Noniij polarS1°MotorOill.
, ,Newer
z�- r
Usages
Stormwater
Benchmarks
redlcarenro
FLOWN appn
circle
mark
100 50
0.1
circle
j3ochmark
50 5110
NIA
s�dard :PPi es
NIA
anty
Standard°ia'PP1lp
1 5
>es gaHmo.
average requires
TO�a and
it �n ar
m Non-polar
Date: Sample
collecteif, ..M
ti.
- - I
Wan
MEW
"
117
A , o
Z!€3. o
O, t
Zba
c z 17
AO
--
Permit Date 101112015 — 9130/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 RO0©K
Additional Outfall Attachment (make copies as needed for additional outfalis)
Stormwater Discharge Outfall (SDO) No. 2_ VMA Outfall? Yes ❑ No f.
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No 0
Was this outfall ever in Tier 2 during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑
3
Outfall No s
`Total,
Rainfall,
inches
„TSS,
° rr�gll
y
SS,
�'mlll .-NTU
- -
� -
;Turbidity,
f , F 1
—Circle -
t ppstr4am
`(Uf Turbidi
�N� NTU
-
Downstream
D ,Turlaidi l
{ ) Ity
}°NTUs:
- - -
`- , ? -
;Non polar
s t
yO&Gmgil
(VMAj,f.
- r
; : New
lNotor 0i1
, ., t
;Usage:.
- allmo__
Stormwater
Benchmarks
mdreare xo
F`O1W ff
Circle...•_
rx
001
-
0.1
'-hMark
50 511 0
NIA
Water Quallty
Standard applies
NIA
Waterauallty.
Standard applies
15
n55 gailmo.
average requlms
TSS and Non -polar
D&G monitoring
Date Sarfi le'
iCollected=.
:;rno/ddlyr
s. 1111111111WEIM
r
MENUIll-
_
Lam
/ Z
r
Permit Date 10/1l2015 — 9/30/2020
Last Revised 10-2-2015

- _ r
Certificate of Coverage No. NCG02 7❑ ZO[
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. lf-� VMA Outfall? Yes ❑ NoX
Is this outfall currently in Tier 2 for any parameter? Yes ❑ NoX
Was this outfall ever in Tier 2 during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑
i •
To ta I
.
• •
• •
s.
• •
• • • -
•: •
• a •
Benchmarks •
MF
I
i •
f - � •
• • •,i.
i i
� fb _ ��
a.
l' � ¢ L�
ems`
P� �
ti._
^?'�J¢�� £ .� V
m� Ji
iFT � "kr_i,� �" �.
A
k-
1 4?r.+.c
1 'C:A Y
� � � 5 7 �„
:"�,{s��R ..
Permit Date 10/1/2015 - 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ®fZ®�
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No �~
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No Q..
Was this outfall ever in Tier 2 during the past year? Yes ❑ No Lk -
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑
Outfall No.
Total
Rainfall,
inches
TSS,
mgll
SS,
m111
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream.,
(D) Turbidity,
NTU
Nora -polar �
O&G, mgll
(VMA)
New
Motor Oil
Usage
allmo.
Stormwater
Benchmarks
indicate NO
apl ica to
Circle
rFLOWifrkk
1 O 11
0.1
circle
enchmarklt
L0 5/1 V
NIA
Standard applies
N/A
Standard applies
1 5
>56 gap=
average requires
lar
T06G monitoSS and ring
Date Sample
Collected,
moiddl it
MEEMM.
M
M
1=
NO
—
Z I Z
2 .o
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑o H[j
CERTIFICATION
"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."
[Required by 40 CFR §122.22]
Signature GUL1-t
Date 2-Az 2�/S
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (Trot DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 10/1/2015 - 9/3012020
Last Revised 10-2-2015

TIER 2 or BENCHMARK EXCEEDENCE DMR - STO tMWAr 'ER
STORMWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000 (MINING)
-Use thes�fot-iit ifyou Hacve EXCEEDEDIBEIVCHMARKSSfor'anyiparameter;or<`ar`e'in Tter �rMonuorrng�Send�sample to§itlts"to�D9VQ Rrgror`uthOfji,
�t_'x _y :��'� v�; �rd �yi'�: t. ;. Via.' k.a r'i�" S?� TYTp'rFt3�, ��+1.h'�y=,� �-.`t �}r."�LX'�'�'fJ.,, a'"3i7:'" r•(a�..� "'.�•. *•li �� a"sa .a/,kt ii.� .'•y.
CERTIFICATE OF COVERAGE NO. NCG02- r ____ SAMPLE COLLECTION PERIOD: 1 ❑ 2 L>
1, OR MONTHLY: ❑` MOON_ TH
FACILITY NAME: `/ /7"� COUNTY �!
PERSON COLLECTING SAMPLES PHONE NO. (5'!a 1 A 7..r R[ar
CERTIFIED LABORATORY Lab # , TOTAL RAINFALL: u' -44,2 INCHES
_Lab # EVENT DURATION; IVMINUTES
Part A: Stormwater Monitoring Requirements
NOV 12 2015
s
E I
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If "NO FLOW ' or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARUE" for each outtall here and the bate Range.
2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or'rier 2 responses in the General Permit.
4TSS benchmark values are 100 mgA except in ORW, HWQ, trout, and PNA waters where they are 50 mgll.
s The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservoirs designated as trout
• , ,. - _1.._._._r.. cn X1111 i r— all r„ l,r,r ctrPams and surface waters. Turbidity may be monitored at the Stormwater Discharge Outfall.
Alternatively, the permittee may cnoose Lu IL10111ML LULU.—� — ..,...,....., .. ____, __- . , ,
Permit Date: 3/l/2010-1213112014 lust Revised 0 1 -1940
Page 1 of 2

F TIER 2 or BENCHMARK EXCEEDENCE DMR - STORMWATER
STO&WWATER DISCHARGE OUTFALLS (SDO)
C E—NER_A.L PERMIT NO. NCGO20000 (MINING)
Oka.
''-„4Q, 7 RiI6n�.-,I;al..-xi`• Zv r '^ -_ h
3fa�any panai�et� [7rBxe°taTrei l�oruzarutg{•lQll1 A6l�L
CERTrFireTF OF COVERAGE NO. NCG02
FACLLITYNAME. A ���7
T'�i{>l lf'l —1 T r, yT 1N(, CAMPLES }
l LILLJ Li
CERTIFIED LABORATORY— IL;;� Lab #
Lab #
Part A: Stormwater Monitoring Re uiremeats
SAMPLE COLLECTION PERIOD: I [- 2
OR MONTHLY: [3 MONTH
COUNTY
PHONE NO. ( a 1 7.r- _
TOTAL R INFAT,T,: r_.�C� - 1NCFIT S Nov
i Z 2015
TOTAL iaau
EVENT DURATION- a TAINUTES
r'°Ao'Ns�K_. v'1 rA
,� �^_� ��
- ,. �
' LA....�+.�kl -... ,_
+i�a •.. .4. - .S. h4
'1� wi.. r{�r,
'ti'sv..
l � ,`.. • i_�k
.a: Y �r.J��J.i-rel-.�T. so-. 5�
]��?,�� � �i �Jy
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X�%'�•'. ""1'x""D
S'3i
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��,.ky����?� '44 ".'Yf4
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ry+er�: !':g' �i#r�.�Ei. r --3
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ri !pp+�
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rl�
a,7 f
l if "NO FLOW -or -NU UnukiArkir'., rrMcl SVV r'L.UY1 tit i14v viJ%..Liru.1-,c lVi GQlli Vll ll Qll ilCll Qlll.l till IJ jSG RQj1�G•
2 Per NCG02: 'Pier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark er within the benchmark range
3 If a value is in excess of the benchmark, or outside the benchmark range (for pl). you must implement the Tier l or Tier 2 responses in the General PerTnit.
4 TSS benchmark values are 100 mgli except in ORW, I IWQ, trout: and PNA waters where they are 50 mg/l.
5 T%- Akrhar2e shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams. lakes. and reservoirs designated as trout
--+..----...w• cn !a-r'r t v..� �11 nlhnr cttpamR arui .surface waters. Turbidity may be mouitored at the Stormwater Discharge Outfall.
Alternatively, the perrnittee may cnoose Lu awitaui tu! unu
Permit Date: 11112010-12131/2014 Last Revised O1-19-10
Page 1 of 2

IKE,
ANNUAL S STO
I VKM WADI LK 00CHAXkYE,
GENERAL PFRMrr NO, N01020000
1.04
ft
Ww-
CERTIFICATE OF COVERAGE No. NCG02—
FACILM NAME- �Vok-
j:;;,
PERSON COLLECTING SAWLM o10--i"'111111t 1P,
CERTIFIED LABORATORY 1�� Ao,,64 C. --Lqb#
-----Lab 9 --
Part A;
ji
20/jo- 1 /V
U, op /,-r' I I
W—
SAMPLE COL"Y'C'folo.0-
A , V
COUNTY . . .... ... ..
pflONF,NO.61-*-)��NOO W"'
ADD TO L1STV-RINCEUES
T0,V,kLRA1DWALL. - NWUT
EVENT btTRATION
jp I
2
2015
NC DENR Raleigh Regional 0
­20
MAY 2 0 2015
'Tv
I,r,7-
ME.
7fgj-1-1�0-re acid the Date r-aUb1,j,,,Wk magO -pernlil-
I If "NO FLOW'or "NO DISCHARGE, Enter "NO FLOW'or "NO DIS E" for MCI' 01 C�Tc mineral
ark Gene gs
1 Per NCCY02: Tier 2 Moathly sampling Shall be done until 3 consecutive samples are below thP-
alid restly"
3 lake -
If a value is in excess of (he benchmark, ar outside the benchmark Mize freshwater sue
4
TSS benchmark values are 100 moo eirr,--f--: -"e-y are 10 t-mj fo�
5— -water
Iremr.nI of the turbidity of the receivir'SZ t1le SDO, LX�t Revised
r, directly upstream 2nd downstream page 1 Q�'2
Alternatively, the permittee may choose to monitor turbidity in the receiving water,
Permit Date: 1/112010-12/31/2014

I ANNUAL SUMMARY DMR - STORMWATER I
31 UKM YYA! EK 1JINUHAKtih OU'1 UALLS (�WV)
GENERAL PERNIIT NO. NCG020000
*Report AII:STDRMWA'�R-Momta tg bats on thts=f .(tneludiiag Io Flow and NotDischarge and Permit LuiiittYiolahians)'by;MARCH k":'
CERTIFICATE OF COVERAGE NO. NCGO2 ^ ^ SAMPLE COLLECTION YEAR;
FACILITY NAME: A d _�� COUNTY ���
PERSON COLLECTING SAMPLES — ^� PHONE NO. io 8 17J-- s"L/ ojo
CERTIFIED LABORATORY /k;r Xi_4 C, Lab # ADD TO LISTERVE? YES ❑ NO ❑ EMAIL:
Lab # TOTAL RAINFALL: A Y G INCHES
EVENT DURATION: IPO MINUTES
Part A: Stormwater Monitoring Requirements
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1 1f "NO FLOW'or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfail here and the Date Range.
2 Per NCO02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
9 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit,
TSS benchmark values are 100 mgll except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
ni n€ the turbidity of the receiving water to exceed: 10 Nfor freshwater streams, lakes, and reservoirs designated
as uvus waWaZ, �� I 4-
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/l/2010-12/31/2014 Last Revised 01-19-10
Page 1 of 2

I ANNUAL S UVIMAR Y DMR - STORMWATER I
SEND T,'CEIVTRALrOF
31 UKM YYAI PK 1J1xNU11AKUh VU TALLN (61)0}
GENERAL PERMIT NO. NCG020000
*Report AGLa.S7 014MWA1ER Monttoring'Dataion this'form;{includyn' `'1�Io Flaw and No, isct ar and°Permit LtrivtrVialatiot s} b MARCR , of each, -year I..1 ' {
g . Y
CERTIFICATE OF CO RA E No. NCG02 0 _5 3
FACILITY NAME: 5� /%ir C'-
PERSON COLLECTING SAMP
CERTIFIED LABORATORY ��" K Jz dC Lab #i l/
Lab #
Part A: Stormwater Monitoring Requirements
SAMPLE CO 'CTION YEAR:
COUNTY �'
PHONE NO.
ADD TO LISTERVE? YES ❑ NO ❑
EMAII,:
TOTAL RAINFALL: /,:
INCHES
EVENT DURATION:
MINUTES
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EP 2 9 2014
I If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range.
2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit.
A TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
5The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes; and reservoirs designated
as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 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/l/2010-12l3112014 Last Revised 01-19-10
Page 1 of 2

I ANNUAL S U MA AR Y DMR - STORMWATER I
Al UKM YVA]EIC 11INUHAKUL UU•ITALLS t5WU)
GENERAL PERMIT NO. NCG020000
Mortttarin Data on tlus form rncludtn' No;F7ow,and;N, Desch �....
p g , :.; (�.g; o> arge andSPermit Ltmrt:Vioiations) by MARCH 1 `of eachyear
Re ort ALL 3T�RMWATER , .-s.. • .: �..:� ._;,.. ,-:• . -
CERTIFICATE OF COVERAGE NO. NCG02
FACILITY NAME: A 01Al
PERSON COLLECTING SAMPLES�i
CERTIFIED LABORATORY Lab # f
Lab #
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2 a ly
COUNTY
PHONE NO.
ADD TO LISTERVE? YES ❑ NO El EMAIL: _
TOTAL RAINFALL: �f INCHES
EVENT DURATION: MINUTES
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2 9 2014
If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range. - ` -
2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General permit.
TSS benchmark values are 100 mgll except in ORW, HWQ, trout, and .PNA waters where they are 50 mgll.
5 The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes; and reservoirs designated
as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTLT 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.
Pernut Date: I/112010-12/31/2014 Last Revised 01-19-10
Page 1 of 2

I ANNUAL SUMMARY DMR - STORMWATER I
■ �r• r 7 � r■ � i 1 • V� _
31 UKJ1 YYAILK ]JINU11AKUh UUATALLS (SVU)
GENERAL PERMIT NO. NCG020000
RECEIVED
APR 2 1 2014
CENTRAL FILES
DWO/BOG
ow and Na Discharge and Permit';Limit-Violati6ns) by MARCH Ir of each)year .:f
* P orutozing Data�an this=form (including' _ .. r.
Re orr ALL STORMWAikk,M 1`lo F1'In 4
CERTIFICATE OF COVE` GE NO. NCG02 ® _'7 7 _J_
FACILITY NAME:
PERSON COLLECTING SAMPLES 01A _
CERTIFIED LABORATORY ab #
Lab #
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:
COUNTY Ic4
PHONE NO.
ADD TO LISTERVE? YESj ❑ NO ❑ EMAIL:
TOTAL RAINFALL: ! - 5 INCHES
EVENT DURATION: 34V MINUTES
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! 11 "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range.
2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit.
4 TSS benchmark values are 100 mgll except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
5 The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes; and reservoirs designated
as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO.
Alternatively, the pernrittee may choose to monitor turbidity in the receiving; water, directly upstream and downstream of the SDO.
Permit Date: 111/2010-12/3112014 Last Revised 01-19-10
Page 1 of 2

F r
. • 4

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average
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r
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEENDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)?
HAVE YOU CONTACTED THE REGION?
WHO AT THE REGION HAVE YOU SPOKEN WITH?
YES ❑ NO Imo"
YES ❑ NO ❑
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW', "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARC_ H_I OF EACH YEAR TO:
Division of Water Quality 1
Attn: DWQ Central piles /
1617 Mail Service Center
Raleigh, North Carolina 276994617
J�
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
'T certify,- under penalty of law, that this document and ,ill 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 the: a are significant penalties for submitting false information, including the possibility of lines and imprisonment for knowing
violations."r% j 1,
(� �,4
(Signature o(Permittee) AMate)
Permit Date: I/l/2010-12131LWI4 Last Revised 01-19A0
Page 2 of 2