NCG210000_Kamps Charlotte DMR_20170316

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
�CG
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ b. D 3 .
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT GENFRAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: 10 17
CERTIFICATE OF COVERAGE NO. NCG210❑�01EJg ttr+ mg report is due a.t [hc Division no later than 30 days from
E the da a th ftrcility receives the sampling results from the laboratory.)
FAC[LITI'NAti kRiPs C(f/d�LLU (�� M�� it''/
11L J' COUNTY Awc(etPLrwyjr _
PERSON COLLECTING SAMPLESTZ?00- i2[.o CENTRAL FILES PIIONE NO. (7c ?) 921 doo
CERTIFIED LABORATORY K-oy Lab # 53`% D�VR SECTION
Lab It PLEA51 SIGI`i ON THE RFVI::RSF. 4
Part A: Specific Monitoring Requirements'
Outfall
No.
Date
Sample Collected,
mo/dd/ yr
Total Rainfall,
inches
00530
00,100
00340
Total Suspended Solids,
m
pH,
Standard units
Chemical Oxygen Demand (COD),
mg/L
Benc mark*
-
-
- 100
Within 6.0-9.0
120
1
.�
g-71
S
:3
S.S
11{
1.1VuuU1 rig is Icquucu only a me tacmty stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects nut to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note: If you rc.porl a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the Gencral Permit.
Facilities that do not nt::;- axposed (either exposed to incident precipitation or exposed in stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical moui,uring may be'waived. For those facilities that qualify for the analytical monitoring waiver, the
discharger shall sign the following certification statement: I
0
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch of -
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
P� IG hQ � � SzGZL ��'i► 6 � , .
?Jame (Print name) '
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Title (Pri title)
319117
g ,lure)
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SWU-245-072808
I of 2

s
DIDTHIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN SS GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
❑ Yes x No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00400
00556
00530,
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gal/mo
pH,
Standard units
oil and Grease,
mg/L
Total Suspended Solids,
mg/L
Benchmark*
-
-
-
6.0-9.0
30
100
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Piles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
)0l: \i 1'ST SIGN TIIIS ('F:1:9'I FI FOIi :AN), INFORMATION REPOR I F0 IN PARTS A .A NDAW B:
"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
possibiliky of fi es and imprisgnment fqr knowing violations."
re
3- 9-/7
(Date) �---
SWU 245-072805
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