NCG140107 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000 RECEIVED
CERTIFICATE OF COVERAGE N0. NCG14 0 l 0
FACILITY NAME: ReAr)v/`4,1aS l; ilr�►
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO:
JUL 13 201tl
SAMPLE COLLECTION YEAR: zDls' CENTRAL FILES
SAMPLING PERIOD: ❑ July -December January -lune DWR SECTION
COUNTY C04,0-4 &4t-T—
PHONE NO. (' 6_1) 22 -q 34?r
ADD TO LISTSERVE? ❑YES [:]NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
Part A: Stormwater
Outfall No.
MonKanng Kegwremen
Date Sample
PH Event
Collected TSS Duration
(Standard
(mo/dd/yr OR Units) (mg/L) (minutes)
NO FLOW)
Total
Rainfall°
(in)
In Tier 2
Monthly
y
Monitoring?
(y/n)
Tier
# of Months in z
2 Sampling
100"s-
-
_
-
IJO
-000
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.
2 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, 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: 7/1/2011-60/30/2015 . Last Revised 7/13/11
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Fart R- WhiAp Maintpnancp Activity Monitoring Rea uirements for facilities using > S5 sal of new motor oil/month — averaged over a calendar year.
Outfall
No.
pH
Date Sample
(Standard
CollectedMonitoring?
(mo/dd/yr}' Units)
6-9
TPH using method
1664A SGT -HEM
-� (mg/L)
15
Total Suspended Event
Solids Duration
(mg/L) ' (minutes)
100 2,3-
Total New Motor Oil In Tier 2 # of Months
a Monthly
Rainfall Usage in Tier 2
(in) (gal/month) (y/n) Sampling 2
- - - -
I
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copv 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
th
os p ons d" tfy responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
Ma ar t r r si .fic�pt penalties for submitting false information, including the possiblljy off* es yd.Lmprisonment for knowing violations."
�; 1- V
(Signature of Permittee)
Permit Date: � 7/1/20 11-60/30/2015
(Date)
Last Revised 7/13/11
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