NCG140158 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual, MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140158
FACILITY NAME: Southern Concrete Materials-Sylva_
PERSON COLLECTING SAMPLES EYeYi e
CERTIFIED LABORATORY ETS Lab # 600
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2015
SAMPLING PERIOD: ® July -December ❑ January -June
COUNTY Jackson
PHONE NO. ( ) _
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout VOther,
Outfall No.
Date Sample P
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard ,
Units)
TSS
(mg/L)
Event
Duration
(minutes).
Total,
Rainfalla -
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
-
6-92
1002s
1
10-2-15
8.2
< 6.2
1660
0.94
N
rICUENED
OV 0
9 -2111L
I FE
DIP= &Ep4n
FILLS
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 responses in the Genera_ I 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/l, 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 rnust 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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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 SGT -HEM
(Mg/0
' Total Suspended
Solids
(Mg/0
Event
Duration
:.
Total
Rainfallo
(in)
New Motor
Usage
(gal/month)
In. Tier- 2
Monthly
Monitoring?
(Y/n)
# of MonthsN
in Tier 2,
Sampling2,
=6-92,
2 `,`
1002,3
-
-
-
_
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YESE] NO ❑
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 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 inquiryof 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 areAgnificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permitt e) (D te)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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