NCG140366 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140 3 6 6
FACILITY NAME: PkT cri N c2eI2 s T1.1 Fc -E. /it C .
PERSON COLLECTING SAMPLES Ic Mkq PgZR( &tj
CERTIFIED LABORATORY_ Lab # I J
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION Y R: - � 0 is
SAMPLING PERIOD: [0 July -December ❑.January -June
COUNTY krh
PHONE NO. (��) aR,3, Q5�0
ADD TO LISTSERVE? []YES []NO EMAIL: ^
DISCHARGING TO CLASS: OSA ❑HQW ❑PNA ❑Trout Other
N6,6j
Date Sample
Collected PH
Outfall No.
- (Standard
1 Units)
NO FLOW)
TSS
(mg/L)
Event
Duration
(minutes)
Total
4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
- - 6-92
1002'3
< Co. ro
IT NO FLOW"" or "NO UISCNAKGL, 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.
each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge.
it Date: 7/1/2011-60/30/2015
iL I I
Last Revised 7/13/11
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rt 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)1
pH
(Standard
Units)
TPH using method
1664A SGT -HEM
_ (mg/L)
Total Suspended Event
Solids Duration
(mg/L) (minutes)
Total_' _
Rainfall
(in)
New Motor Oil
Usage
(gal/month) --
In Tier 2
Monthly#
Monitoring?
(y/n)
of Months
in Tier 2
Sampling2
6-92
152
1002'3 -
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDE CES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO19/
HAVE YOU CONTACTED THE REGION? YES ❑ NO V
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 inquiry of the person or persons who manage the system, or
those persons directly responsibl for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware that t are si i t penal es or submitting false information, including the possibility of nes a d imprisonment for knowing violations."
l �S\
(Signature o Permittee) (Da e)
Permit Date: 7/172 ii. -W30/2015 Last Revised 7/13/11
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