NCG140105 DMR SW (2)

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STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 6 l D 5"
FACILITY NAME: 141 i06
PERSON COLLECTING SAF41PLES
CERTIFIED LABORATORY ,le:-W/,cr AdWl I—_ Lab # 1n43
Lab #
OPTIONAL INFO:
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i
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: ❑ July -December [,January -June CEIVL)
COUNTY _
PHONE NO. (25L)&3'i-`+1 MAY 0 1 2015
ADD TO LISTSERVE? []YES ❑NO EMAIL:
DISCHARGING TO CLASS: []SA ❑HQW ❑PNA ❑Trout ❑L
lo/VftAErLIFr
V
Part A: 5tormwater ivionnonng Kequ1re1_"e11U-
Date Sample Event ,
Collected PH TSS Duration
Outfall No. (Standard
(mo/dd/yr OR (mg/L)
NO FLOW)t Units) (minutes)
I
Total
Rain
(in)
In Tier 2
Month! y
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
_ 6-92 1002'
d b
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the camp a per a ove.
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/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 must be recorded using data from an on-site rain gauge.
; Last Revised 7/13/11
Permit Date: 7/1/2011-60/30/2015
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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.
pH
Date Sample
Collected (Standard
(mo/dd/yr)' Units}
6-9
TPH using method
1664A SGT -HEM
(mg/L)
15
Total Suspended Event
Solids Duration
(mg/L) (minutes)
100 , -
Total New Motor Oil In Tier 2 a of Months
a Monthly
Rainfall Usage in Tier 2
Monitoring?
(in) (gal/month) (y/n) SamplingZ
- -
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEED CES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NOX
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Oriainal and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for 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
thoNr
rso irectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
amet here are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Sig ture Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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