NCG140099 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. MGM z ilk SAMPLE COLLECTION YEAR:2016
FACILITY NAME: Chandler Concrete Company-Sparta 505 SAMPLING PERIOD: El July-December ®January-June
COUNTY Alleghany
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY:Blue Ridge Labs Inc. Lab#275 PHONE NO. (336) 372 - 4348
ADD TO LISTSERVE? OYES //NO EMAIL: _
OPTIONAL INFO: Lab# DISCHARGING TO CLASS: ESA ❑HQW ❑PNA ❑Trout ►Other: C
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2
pli Event Total
Collected TSS4 Monthly #of Months in Tier
Outfall No. (Standard Duration Rainfall 2
(mo/dd/yr OR (mg/L) Monitoring? 2 Sampling
Units) (minutes) (in)
NO FLOW)1 (yin)
- - 6-92 1002'3 - - - -
1 NO FLOW - - - - Y 12
t . ECF; ❑D
AUG Z[116
ifti
CENTRAL FILLS
OWN ECTION
i : :, e ,:,', . , i ':°13 ',. 1, 6' : '
1 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. ,Original State
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. ❑ Copy - State
❑ Copy - Plant
❑ Copy - File
Permit Date:7/1/2011-60/30/2015 Last Revised 7/13/11
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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.
In Tier 2
pH TPH using method Total Suspended Event Total New Motor Oil #of Months
Outfall Date Samplea Monthly
(Standard 1664A SGT-HEM Solids Duration Rainfall Usage in Tier 2
No. Collected Units) (mg/L) (mg/L) (minutes) (in) (gal/month) Monitoring? Sampling2
(mo/dd/yr)1 (Y/n)
6-92 152 100'3 - - - -NOT
APPLICABLE
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 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 re-Ionsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I
am aware that a/signif n en ties for submitting false information, including the possibility of fines an imprisonment for knowing violations."
z.
(Signature of Permittee) (Da e)
Permit Date:7/1/2011-60/30/2015 Last Revised 7/13/11
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