NCG020437 DMR SW

J
ANNUAL SUMMARY DMR STORMWATER
II SEND TO CENTRAL OFFICE * II
STORMWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
*Report ALL STORMWATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH 1 of each year.
CERTIFICATE OF COVERAGE NO. NCG02 0 4 3 7 SAMPLE COLLECTION YEAR: 2014
FACILITY NAME: Hanson Brick,.- Sampson II Mine COUNTY Sampson
PERSON COLLECTING SAMPLES Martin Brown PHONE NO. ( 910 ) 525-4128
CERTIFIED LABORATORY K&W Laboratories Lab # NC 559 ADD TO LISTSERVE? YES ❑ NO ❑ EMAIL:
Lab #
Part A: Stormwater Monitoring Reauirements
Outfall
No..
Date Sample
Collected'
('mo/dd/yr OR
NOFLOW)t
In Tier'2',
# of Months in
Monthly, �.
Tier 2
Monitoring? Z
(y/n) Sampling•
Total Suspended
Totafflow
— Solids`
�,(MG) (m>)
a "
Turbidit y
(NTU)
Total Event
Settleable
Rainfall . Duration
Solids(rril/1)- (in)
1003' 4 ,.
te3
See Footno'0.13
S-003
No Discharge
1/01/2014 to 06/30/2014
S-003
No Dischar e
7/01/2014 to 12/31/2014
ul:�FRAL F1
' 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.
4 TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/1.
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 permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/1/2010-12/31/2014
Last Revised 01-21-11
Page 1 of 2

Part B: Vehicle Maintenance Activitv Monitoring Requirements for facilities usine > 55 gal of new motor oil/month on average
Date Sample ' In Tier 2 '
P
Outfall Col ected� #•of Months
Monthly '
m Tier 2'
No. a Sampling
. (ino/ddlyr OR ..Monitoring.
1 p g�
:.. FLgW )
,New Motor
Oil Usa g e'
gw)
� �
(aUnionth)
...._.
Total Flow;_ TPH.using method
G 1664A SGT="
(m HEM
Total Suspended'
Solids '
(m )
pH Total E 'Event.._;
(Standard Rainfall, Duration-.:
• -
Units) (in) (mu es) `
nut
° -100
s:
6-9
S-003
01/01/2014 to 0 /30/2014 - No Dischar a
<55
S-003
07/01/2014 to 12/31/2014 - No Discharge
<55
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑X
HAVE YOU CONTACTED THE REGION? YES ❑ NO
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH 1 OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
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 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.."
/1 • 1 �--- Z 9 LD S
(Signat, •e of Permittee) (datef
Permit Date: 1/1/2010-12/31/2014 Last Revised 01-21-11
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