NCG140332 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (Such) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 0 3,'3 2
FACILITY NAME: POWELL'S READY -MIX CONCRETE
PERSON COLLECTING SAMPLES J D FREI/ SwSG
CERTIFIED LABORATORY PACE LABS Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Reauirements
-®�SAr�nIILE COLLECTION YEAR: 2015
JO I SAMPLING PERIOD: ® July -December
COUNTY HALIFAX
CENTRAL FIpyONE NO. [phone]
40JWR SEC'Fl;A,bb TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: [:]SA ❑HQW
❑ January -June
❑PNA ❑Trout ®Other r=
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(Y/n)
# of Months in Tier
2
2 Sampling
-
-
6-92
1002'
-
-
-
-
001
12/28/15
7.58
46.2
+/-120
0.15"
N
n/a
0
1 r,
1.7
my Jul',
' 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 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/I.
4 For each sampled measurable storm event the total precipitation must 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: V a Maintenance Activity Monitoring Requirements for facilities using > of of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)1
pH
(Standard
Units)
TPH using method
1664A SGT -HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfalla
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
2
Sampling
6-92
1s2
1001'3
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Orieinal and one copv of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitorine 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
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there re signi nt penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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