NCG140107_MONITORING INFO_20180103

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
1 ° /v G&
DOC TYPE
❑ HISTORICAL FILE
9 MONITORING REPORTS
DOC DATE
❑ a 0 i S o I 06
YYYYM M DD

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N0. NCG140 1 D 7
FACILITY NAME: "" . J = l� /
PERSON COLLECT}NG SAMPLES
CERTIFIED LABORATORY_ Lab f#
Lab ft
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:1-7
SAMPLING PERIOD: [,July -December ❑ January -June JQ� a `� 2�, i
COUNTY C kn-tz- 'r IMP 3ECTION
PHONE NO. j 2j2Z3-y$r INFOR14ATIONPROCESSING UNIT
ADD TO LISTSERVb []YES []NO EMAIL:
DISCHARGING TO CLASS: []SA ❑HQW ❑PNA []Trout []Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)t
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total `
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
I# of Months in Tier
2
2 Sampling
-
-
6-9
100 '
-
-
i
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.
If a value is In excess of the benchmark, oroutside 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.
`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
Page 1 of 2
Date of last pH meter calibration:

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/monlh — averaged over a calendar year.
Outfall
No.
Date Sample
p
Collected
(mo/dd/yr)'
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall°
(in)
New Motor oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling2
6-9
1s
100 ,
-
-
-
I
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 iincludine all "No Flow" & "No Discharge" reports) within 30 days of receipt of sarnole for 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 docu nt and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly her evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly res n ibl f r g herin th information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete,
am aware that there are ig fic nt a alties r bmitting false information, including the possibility of fines and imprisonment for knowing violatlons."
Z-Zl
(Signature of Permittee '; (Date)
Permit Date: 7/1/2011-60/30/201S Last Revised 7/13/11
Page 2 of 2

f
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COV GE N0. N§G140 I Ci -2 SAMPLE COLLECTION YEAR:FACILITY NAME: -/ "/� �� ,SAMPLING PFRIQD: July -December January -June
PERSON COLLECTING SAMPLES / e wo Ge rn COUNTY
CERTIFIED LABORATORY Lab # N V / PHONE NO. ( )
Lab N ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: []SA ❑HQW ❑PNA []Trout ❑Other
Part A. Stormwater Monitoring Requirements
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOWjl
p H
{Standard
Units)
TSS
(mg/Lj
Event
Duration
(minutes)
Total
Rainfall°
(in)
In Tier 2
Monthly
Monitorin
(
Months inz ier
2 Sampling
-
-
6-9z
100�'
-
-
JUN
r, c
UV "e
HLES
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.
3 TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/t.
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
"I
Permit Date: 7/1/2011-60/30/2015 i Last Revised 7/13/11
Page 1 of 2

29 0
11
Fart B: Vehicle Maintenance Activity Monitoring Requirements for facilities using a 55 gat of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)'
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthl
M ring?
Wn)
t-of-Ralos
in Tier 2
x
Sampling
6-9
is
100 ,
-
-
-
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 coov of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receint of sample for at end of monitoring period
in case of "No Flow") to:
Division of Water Quaiity
Attu: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MAST SIGN THIS CERTIFfGATION 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 perso d' ctly p nsi le f r gather'ng the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aw h t er a ig if'for submitting False information, including the possibili of fines nd ' risonment for knowing violations."
(Signature of Permittee) ' (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVEGE No. N G14(j -
FACILITY NAME: l,7�65 �I�C� / "! 1 3�7
PERSON COLLECTING SAMPLES 1 Qr
CERTIFIED LABORATORY
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
Lab #
Lab #
SAMPLE COLLECTION YEAR:/
SAMPLING PftlQ C' 1ulDecember January -June
COUNTY C /j
PHONE NO. { j `' 7 D
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑RNA []Trout ❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
PH
(Standard
Units?
T55
(mg/L)
Event
Duration
(minutes}
Total .
Rainfall
{in)
In Tier 2
Monthly
Monitorin
Months in Tier
z
2 Sampling
6-92
100'
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.
3TS5 benchmark values are 300 mg/1, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
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
Page 1 of 2

Part 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}'
PH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
MonthI
M ' ring?
(y/n)
onths
in Tier 2
i
2'
Sampling
15
100 '
-
-
i
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail DriQinal and one copv 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: OWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THJS 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 perso d' ctly p nsi le f r gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aw, h t er a ig if' a t I . for submitting false information, including the possibili of fines nd m risonment for knowing violations."
(Signature of Permittee)
Permit Date: 7/1/2011-60/30/201S
(Date)
Last Revised 7/13/11
Page 2 of 2

F
Sf6 iVVl ATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAG!SAMPLE COLLECTION YEAR: Zn j s _
NO NCG14 �D
dr _&
FACILITY NAME: p �?� ul • PERT JDecember ❑ Jan>Jary�--tune
PERSON COLLECTING SA PLES ' U' NTY
CERTIFIED LABORATORY _ Lab # DEL V& i.9
Lab # ADD TO LISTSERVE? []YES [:]NO EMAIL: �
OPTIONAL INFO: N I I0tSCFiAR%NG TO CLASS: ❑SA ❑FIQW ❑PNA ❑Trout [f btiheri^
Part A: Stormwater Monitoring Requirements JR SECTION L
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes]
Total .
Rainfall
[in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling'
-
6-9
100 '
-
-
-
►E
cl CN koN
t 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/1, except when discharging to ORW, HQW, Trout, and PNA waters where they are So mg/I.
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
Page 1 of 2

Part B: Vehicle Malnt, 1,W�'A_averaged over a calendar year. ctivity Monitoring Requirements for facilities using > 55 gal of new motor oil/month
Outfall
No.
Date Sample
Collected
(rno/dd/yr)'
pH
(Standard
Units)
TPH using method
1664ASGT-NEM
jmg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
Wn)
# of Months
in Tier 2
Z
Sampling
6-9
1s
100 '
-
-
-
-
I
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 OMR (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 MUSTSIGN 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 p rso el properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those r o s irectl es nsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am a ar t ther r ' ni icant penalties for submitting false information, including the possibility fines a d imprisonment for knowing violations."
(Signature of Permi tee) ` (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

0 0
-i
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL. PERMIT NO. NCG140000 RECEIVED
CERTIFICATE OF COVERAGE N0. NCG14 8 l 0
FACILITY NAME: RSA. tA,!( 1 LJ.c;i -
lb -PERSON COLLECTING SAMPLES —
CERTIFIED LABORATORY
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
Lab R
Lab #
JUL 13
202�
SAMPLE COLLECTION YEAR; CENTRAL
SAMPLING PERIOD: ❑ July -December January -June DWR SE FILES
COUNTY Cr4�.4 ��T DWR SEC7'!ON
PHONE NO. (ZSyi
ADD TO LISTSERVE? RYES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA [-]Trout []Other
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 Tler 2
Monthly
�
Monitoring.
(y/n)
# of Months in Tier
2 Sampling,
-
6-9
100
IP
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/l.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
rpmm
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Triol Ull 0
•

•
Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
butfall
Na.
Date Sample
p
Collected 1
(mo/dd/yr}
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
z
Sampling
6-9
15
100 '
-
-
-
-
I
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 CERTIFfCATION 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
thos p ons d' tly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
a ar t r r sig 'fit penalties for submitting false information, including the possibly of fipets_Ydiu�prisonment for knowing violations."
/ J
(Signature of Permittee)
Permit Date: 7/1/2011-60/30/2015
(Date)
Last Revised 7/13/11
Page 2 of 2