NCG140105_DMR_20210321

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF C VERAGE N0. N G14 v I
FACILITY NAME: CyI.,DS 1%S/�
PERSON COLLECTING S MPLES A l�
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO:
SAMPLE COLLECTION YEAR: ZVV
SAMPLING PERIOD: July -December anuary-June
COUNTY
PHONE N0. }�'L) (0 / 7
ADD TO LISTSERVE7 []YES [:]NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout []Other
Part A: XOrmWaier
Outfall No.
rvwmrunng neyun oncuw
Date Sample
Collected
(mo/dd/yr OR
t
NO FLOW)
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall'
lint
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
z
2 Sampling
_
-
6.91
Do,,
-
-
-
Mar 2 7 211?j
l
,crs,f-IL.
tN
' 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.
1 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. 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, HOW, Trout, and PNA waters where they are 50 mg/I.
' For each sampled measurable storm event the total precipitation must be recorded using data fggm a9,ol�-site rain gauge.
f 1 H 141, 3 L/` r `I I Last Revised 7/13/11
Permit Date: 7/1/2011-60/30/2015 D ate o aSt p meter cat ration.
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)'
pH
(Standard
Units)
TPH using method
1664A WT--HEM
(mgAL)
Total Suspended
Solids
(rng/L)
Event
Duration
(minutes)
Total
o
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
W/O
# of Months
in Ter 2
Sampling2
6-92
1Sz
1002,3-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC T ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Orieinal and one conv 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
:Iscer.lifndr pqnally of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
surha q ifsonnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those a on iresponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am a r th si ' ' nt penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
21 ,G�v
(Signatu of Perm' ee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2