NCG020048 DMR SW

11
11 TIER 2 or BENCHMARK EXCEEDENCE DMR - STORMWATER 11
111 .:Fif 11JL
r
STORMWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000 (MINING)
Use this form if you have EXCEEDED BENCHMARKS for any parameter or are in Tier 2 Monitoring. Send sample results to DWQ Regional Of/ice within 30 days of receipt
from lab.
CERTIFICATE OF COVERAGE NO. N402 K s
PERSON COLLECTING SAMPLES fl Cx
CERTIFIED LABORATORY VilleLab #
Lab # _
Part A: Stormwater Monitorine Re uirements
SAMPLE COLLECTION PERIOD:1 2'-2--0
MONTHLY: MONTH
FACILITY NAME:
COUNTY a
PHONE
Outfall
No.
Date Sample In Tier 2'
Collected ' ' Monthly
(mo/dd/yr OR Monitoring?
NO FLOW) (y/n)
# of Months
in Tier 2 Total Flow,
Sampling2 (MG)
Total Suspended a
Turbidity Settleable Total
Solids (NTU) Solids (ml/1) Rainfall
(mg/1) (in)
Event
Duration'
(minutes)
-
- -
-' -
-100-7-r- See Footnote ' 0.1
—
v
—
L4
/
a
MAR 2 0
2015
QWR SECTION
'If "NO FLOW'or or "NO DISCHARGE, Enter "NO FLOW'or 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/l.
s 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 Stormwater Discharge Outfall.
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
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I
Part B: Vehicle Maintenance Activit onitoring Requirements for facilities using > 55 gal of new motor oil/month on avers e
Outfall
No.
Date Sample,
Collected
(mo/dd/yr OR
t
NO FLOW)
�, ln`Tier 2
Monthly
Monitoring?
(y/n)
#'of
New Motor Oil
Months in
Usage
Tier 2
2 (al/month)
Total Flow TPH using
(MG) method 1664A
SGT -HEM (m )
Total Suspended
Solids
( )
pH' Total Event-,
(Standard Rainfall Duration
Units) (in) (minutes)
Sampling 15 mg/13 100 1119/13
6-93
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEENDENCES AT YES ❑ NO
ANY ONE OUTFALL (ALL SDOs INCLUDING VEHICLE MAINTENANCE)?
HAVE YOU CONTACTED THE REGION? YES ENO ❑
WHO AT THE REGION HAVE YOU SPOKEN WITH?
USE THIS FORM IF YOU HAVE EXCEEDED BENCHMARKS FOR ANY PARAMETERS.
SEND THIS DMR TO YOUR LOCAL DWO REGIONAL OFFICE WITHIN 30 DAYS OF RECEIPT OF SAMPLE RESULTS FROM THE LAB:
Asheville Regional Office (ARO)
Roger Edwards, Surface Water Protection
Supervisor
2090 US Highway 70
Swannanoa, NC 28778
COURIER 12-59-01
Phone: [phone]
Fax: [phone]
Fayetteville Regional Office (FRO)
Belinda Henson, Surface Water Protection
Supervisor
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
COURIER 14-56-25
Phone: [phone]
Fax: [phone]
Mooresville Regional Office (MRO)
Rob Krebs, Surface Water Protection
Supervisor
610 East Center Avenue, Suite 301
Mooresville, NC 28115
COURIER 09-08-06
Phone: [phone]
Fax: [phone]
Raleigh Regional Office (RRO)
Danny Smith, Surface Water Protection
Supervisor
3800 Barrett Drive
Raleigh, NC 27609
COURIER 52-01-00
Phone: [phone]
Fax: [phone]
Washington Regional Office (WaRO)
Al Hodge, Surface Water Protection
Supervisor
943 Washington Square Mall
Washington, NC 27889
COURIER 16-04-01
Phone: [phone]
Fax: [phone] or [phone]
Wilmington Regional Office (WRO)
Rick Shiver, Surface Water Protection
Supervisor
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
COURIER 04-16-33
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office (WSRO)
Steve Tedder, Surface Water Protection
Supervisor
585 Waughtown Street
Winston-Salem, NC 27107
COURIER 13-15-01
Phone: [phone]
Fax: [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."
— (Signature of Permittee)
Permit Date: 1/1/2010-12/31/2014
9-j4�i5
(Date)
Last Revised 01-21-11
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