NCG140035 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N0. NCG14� ) 6
FACILITY NAME: 1012,19N
PERSON COLLECTING&AMALES ?
CERTIFIED LABORATORY L' `t Lab # &57/
Lab #
OPTIONAL 1N FO:
i
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: ❑ July -December January -June
COUNTY lee
PHONE NO'(—I&)
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: DSA ❑HQW ❑PNA []Trout ❑Other
Part A: Stormwater Monitoring Requirements
Date Sample
PH
Collected Standard TSS
Outfall No. {
(mo/dd/yr OR Units) (mg/L)
NO FLOW)
Event
Duration
(minutes]
Total a
Rainfall
{in)
In Tier 2
Monthly # of Months in Tier
Monitoring. 2 Sampling's i
(y/n)
/}
i
L....., nl_y
—nlio giro to marlr
tho camnle period above.
'If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW or --NO Ui?ldlAKUt TUI edl-n vuuon -• - .- •••-••- -••- ----
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.
'TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
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 I
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