HomeMy WebLinkAboutNCG140138 DMR SW (2)STORMWATER DISCHARGE OUTFALL (SDO) - Serpi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000.
CERTIFICATE OF. COVERAGE NO. NCG144.�- SAMPLE COLLECTION YEAR;
FACILITY NAME: („ SAMPLING PERIOD: ull
PERSON"COLLECTINS MPLE , w COUNTY
G (%
CERTIFIED LABORATORY Labe#
PHONE NO. I) Illy
LYcZ�Lab # ADD TO LISTSERVE? YES
OPTIONAL INFO: DISCHARGING TO.CLASS: [
-December ❑ January -June .
NO EMAIL:
❑HQW QPNA ❑Trout ther-a _
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 benchmarks 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/l.
° For each sampled measurable storm event,the total precipitation must be -recorded using data from an on --site rain gauge.
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Permit Da 1/2011-60/30/2015 • Last Revis-6-2113/11
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Dart*R- Vphirlp Maintenance Activitv Monitorine Requirements for facilities using >•al of new motor oil/month - averaged over a calendar year.
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HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NOV
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy 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 6f"'N6 Flow") to: _
Division of Water Quality
Attn: DWQ Central Files.
1617 Mail Service.Center
Raleigh, North Carolina 27699-1617
"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 fo- gath ing the • 1 formation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware that there are signifi pe bees for sybmitting false information, including the possibility of fines and imprisonment for knowing violations."
1
(Signature o ermittee) (Giate
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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