NCG140135_MONITORING INFO_20190215

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V Gc,
DOC TYPE
❑ HISTORICAL FILE
5� MONITORING REPORTS
DOC DATE
❑
YYYYM M DD

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14_ _ _
FACILITY NAME: / l
PERSON COLLECTIN SAMPLES
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
REcEIVED
SAMPLE COLLECTION YEAR: lei��kl I FEB 15 2019
SAMPLING PERIOD. ❑ July -December anuary-JunENTRAL FILCH
COUNTY 'SECT -ION
PHONE NO.
ADD TO LISTSERVE? ❑YESES [:]NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout ❑Other
Outfall Na.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Totaf
,
Ra}nfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Samplingz
-
6-92
100 ,
-
-
-
-
.z3�0
e �"
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/l,
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Hate: 7/1/2011-60/30/2015 Date of last pH meter calibration:
Last Revised 7/13/11
Page 1 of 2

Part S: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 5S gat of new motor oil/month — averaged over a calendar year.
1!
Outfalf
No.
Date Sample
p
Collected
jmo/dd/yr)'
pH
(Standard
Onus)
TRH using method
1654A 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?
Wn)
# of Months
in Tier 2
2'
z
Sampling
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 coi)v of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample 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 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 haL the ar sign' is nt penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
a_ f_
(Signatu a of Permittee) I. (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 N0. NCG140000
CERTIFICATE OF COVERAGE N0. NCG 40 _L 3 5
FACILITY NAME:
PERSON COLLECTING S MPLES i
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: Q-0/8
SAMPLING PERIOD: [K] July -December ❑ January -June
COUNTY 0jv
PHONE NO, ( -1/0 )_3 — �q
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: []SA ❑HQW ❑PNA ❑Trout ❑Other,
Outfall Na.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard
Units)
TSS
(mg/1-1
Event
Duration
(minutes}
Total a
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
ly/n)
# of Months in Tier
2 SamplingI
-
-
6-9
100
041
-7-2-
07
19 yjr
00
•I
�`FIaT'E-r
1i
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.
Z 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 T5S benchmark values are 100 mg/l, 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/l/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2
Date of last pH meter calibration:

i
•
;�.'
Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Hate Sample
Collected
(mo/dd/yr)'
pH
(Standard
Units)
TPH using method
1664A 5GT-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
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 Orieinal and one coov of this DMR (including all "No Flow" & "No Discharge" reports) within 3D days of receipt of sample for 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 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 are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
- -C a
(Signs re of Permittee (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

& 0 0
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG 1a-a 1 .�
FACILITY NAME: , -/' 1 1(j PERSON COLLECTING SAW P ES C6&i w�
CERTIFIED LABORATORY Lab r#
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
*� }} RCCEIVI=n
SAMPLE COLLECTION YEAR: aj�L I FEB 13 SAMPLING PERIOD: ❑ July -December -1 anuary-June 2p�$
COUNTY DN - .DU5 r D� TRAL FILES'
PHONE NO. (910 ) R SECTI014
ADD TO LISTSERVE? []YES FIND EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout ❑Other
Outf all Na.
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)
q of Months in Tier
2 Samplingz
104 ,
-
-
ti rJ
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 pHl, 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 fromanon-site rain gauge.
Permit Date: 7/1/2011.60/30/2015 Date (it si
last pH meter Calibration: j - G + r( I ; Last Revised 7/13/11
Page 1 of 2

E
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
(rng/Lj
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
Win)Sampling
+Y of Months
in Tier 2
z
6-9
15
100 '
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDE CES AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES NO
REGIONAL OFFICE CONTACT NAME:
Mail Original and one conv of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring veriod
in case of "No Flow") to:
Division of Water Quallty
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 pen
alt of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure thKd2
Isn
I properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those petible for gathering the information, the information submitted is, to the best of my knwledge and belief, true, accurate, and complete
am awareicant penalties for su itting false information, including the possibil o fines mprisonment for knowing violations."
(Signature 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 COVERAGE Ns. NCG14 V 13 9
FACILITY NAME:
PERSON COLLECTING SA PILES
CERTIFIED LABORATORY_ A& Lab # /w
Lab #
OPTIONAL INFO:
PartA: Stormwater Monitoring Requirements
SAMPLE COLLECTION YE R; ZO/ 1
SAMPLING PERIOD: PI u(y-December ❑ January -June
COUNTY OA- �(&O
PHONE NO. (��) $
ADD TO LISTSERVE7 []YES []NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout []Other
Outfal! 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
Monitoring?
(y/n'
A of Months inTier
2 Sampling
-
-
6-9Z
100�'
-
-
-
A
n- AL .
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.
z 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.
a TSS benchmark values are 100 mg/l, 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.
Permit Date: 7/1/2011-60/30/2015
Date of last pH meter calibration: ` rl Z/
7
V ED
2017
-ILEA
-1QN
I Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gat 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
1564.4 SG7"•NEM
(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?
iy/n}
�
# of Months
in Tier 2
Sampling 2
6-9
15
100 '
-
-
I
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EKCEEDENCES 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 OMR (including all "No Flow" & "No Discharge" reoortsl within 30 days of receipt of sample for at end of monitoring period
in case of "No Flow") to:
Division of Water QualityT
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 ' ectly responsible for gathering the information, the information: submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware th e r i nt penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
ZG . i
(Signature Permi ee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

• s s
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
.00
CERTIFICATE OF COVERAGE NO. NCG14 D y?
FACILITY NAME: iawi7 li?
PERSON COLLECTING SAM LES,L�A�'
CERTIFIED LABORATORY_�r,+a��ilstrtr 1 Lab tt
Lab R
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: Zo"t 7
SAMPLING PERIOD: ❑duly -December 2kanuary-June
COUNTY O `l
PHONE NO. (t9) L"
ADD TO LISTSERVE? ❑YES []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
.
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
-
-
6-91
100 '
-
-
-
d af/
r
R
LES
SEC
i
r 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 T5S benchmark values are 100 mg/l, 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.
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
Page 1 of 2
Date of last pH meter calibration: l� I

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 j
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
1664A SOT -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
Sampling2
6-9
1s
100 ,
-
-
-
-
I
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDEN 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" reoortsl within 30 days of receipt of samoie for 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 resRL
a for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am" a r t. t the re snt nalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
-A�
'z�r—//
(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 CO�,� COVERAGE N0. NCG140 5
FACILITY NAME: ArvvS ZeA44 P,X , It
PERSON COLLECTING"SAMPLES
CERTIFIED LABORATORY eA/Ny ! _ Lab lc -
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLING PERIO July -December ❑ January -June
COUNTY N
PHONE NO, (�}
ADD TO LISTSERVE? YES []NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW [—]PHA []Trout []Other
Outf all No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
(Standard
(Standard
Units}
T55
(mg/L)
Event
Duration
(minutes)
Total 4
Rainfall
{in}
16 Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
:
2 Sampling
-
-
6-92
1002,
-
-
-
KAL FE
'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.
7 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.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
D
16
ES
)N
Permit Date: 7/1/2011-60/30/2015 ; Last Revised 7/13/11
Page 1 of 2

E
•
•
Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using> S5 gal of new motor oil/month —averaged over a calendar year.
Outfall
No.
Date Sample
Collected j
(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 Z
Sampiing2
6.g
is
100 '
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEED LACES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO F
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copv of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for 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 responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am rake thatthere.pre *nificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
'�Z l
(Date)
Permit Date: 7/1/2611-60/30/2015 Last Revised 7/13/11
Page 2of2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 f� �
FACILITY NAME: rPd
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY.F-0 (_) z4 Zy1 lab # / 9
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTIONFl�l
o� 15
SAMPLING PERIOD: -December ❑ January -June
COUNTY ._ r?
PHONE N0, 010 3 41 �p
ADD TO LISTSERVE7 DYES ❑NO EMAIL:
DISCHARGING TO CLASS: [-]SA ❑HQW ❑PNA ❑Trout ❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
PH
(standard
units)
TSS
(mg/L)
Event
Duration
(minutes)
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(yin)
# of Months in Tier
2 Sampling'
6-9
lUt) '
-
-
-
-
RE
2-
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.
ED
115
.ES
)N
Permit Date: 7/1/2011-50/30/2015 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 56T-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)
i
it of Months
in Tier 2
Sampling2
6-9
15
100
14
HAS YOUR FACILITY HAD a 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 Driginal and one coov of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for at end of monitoring period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQCentraI 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. I
am awa t at they are signif! selpe Ities 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
Page 2 of 2

i
STORMWATER DISCHARGE OUTFALL 4SDOj - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N0. NCG14 0 1 3 S
FACILITY NAME: AA&P51 " -A
PERSON COLLECTING SAMPLES LtS
CERTIFIED LABORATORY&,✓td* VLt 7 I Lab 9 IaQZ
Lab #
OPTIONAL INFO: _
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: July -December nuary-June
COUNTY `D14IMS
PHONE NO.
ADD TO LISTSERW ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout ❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
PH
(S
Units)
TSS
(mg/L)
Event
(minutes)
-Total
4
(in)
In Tier 2
Monthly
Monitoring?
(y/n
# of Months in Tier
2 Sampling'
-
-
6-92
100
-
J c
----
];I2
a Znl�
6 -3- 1
1 If "NO FLOW" or "NO DISCHARGE., Enter" NO FLOW" or "NO DISCHARGE" for each outf all here. Please make sure to mark the sample period above.
2 !f 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 TS5 benchmark values are 100 mg/l, 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 clata 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 usi 55 gal of new motor oil/month —averaged over a calendar year.
r.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)'
pH
(Standard
Units)
TPH using method
1564A 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?
i (y/n)
i
# of Months
in Tier 2
z
Sampling
6-9
15
100
HAS YOUR FA0Li7Y HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE 0UTFALL (INCLUDING VEHICLE MAINTENANCE)? YES []NO
❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Orieinal and one coon of this DMR (includine all "No Flow" & "No Discharp-e" reports) within 30 days of receipt of sample (or at end of monitoriniz 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 beiief, true, accurate, and complete
am • are that sere ar ignifi ant penalties for submitting False information, including the possibility of fines and imprisonment for knowing violations."
7_
(Signature of Permittee (Date)
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
Page 2 of 2