NCG140116_DMR_20221114

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14_ '
FACILITY NAME: &2qe1_1 O>A
PERSON COLLECTING SAMPLESK!L-,�
CERTIFIED LABORATORY lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: July -December ❑ January -June
COUNTY
PHONE NO, { 1 7-
ADD TO LISTSERVE? DYES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA FTrout []Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfal{ ,
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Samplingz
-
6-9z
loo"
-
i-
ZZZ,2
U
32
2
2—
'/
tl�
3:
I
t
L
1 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.
z 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.
a T5S benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/1.
° For each sampled measurable storm event the total precipitation must be recorded using data from an en -site rain gauge.
Permit Date: 7/l/2011-60/30/2015
Date of last pH meter calibration: X�
Last Revised 7/13/11
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Part R- Vahirla Mnintananra Art{uiti.
Outfall
No.
Date Sample
Collected.
(mo/dd/yr)'
pH
(Standard
Units)
6-9
TPH using method
1664ASGT-HEM
(mg/L)
15
...,...5 _ ,,
Total Suspended
Solids
(mg/L).
lU
aa, V. mw 11ju.u,
Event
Duration
(minutes)
myrnonin-averaged
Total
Rainfall"
(in)
over calendar
New Motor Oil
Usage
(gal%month)
year.
In Tier 2
Monthly
Monitoring?
(y/ni
# of Months
in Tier
Z
Sampling
ARK EXCEEDENC AT ANY ONE 0UTFALL (INCLUDING VEHICLE MAINTENANCE)? YES No
HAVE YOU CONTACTED THE REGION? YES 0 NO
REGIONAL OFFICE CONTACT NAME:
No flow & "No Discharge" reports) within 30 days of rPcaint of care„lo f—
in -case -Or
- -....
0 0: _.
bivision of Water Quallty
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 Pena_ Ity of law, th this document and all attachments were prepared under my direction or supervision in accordance with as ystem designed to
assure that ifie o el ro erly gather and evaluate the information submitted: Based on my inquiry of the person or persons who rrianage.the,system, or
those pers dir t resp n bi for gathering.the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. 1
am awar t t e res gn' nt penalties for submitting. false. information, including the possibility of fines and imprisonment for' knowing violations."
(Signat6,of Permit e) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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