NCG140262_MONITORING INFO_20180101

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
�V
DOC TYPE
❑ HISTORICAL FILE
6� MONITORING REPORTS
DOC DATE
❑ Ppl K (A 01
YYYYM M DD

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCGI40000
CERTIFICATE OF COVERAGE N0. NCG14 6 2
FAGLITY NAME: S S++t•+n t
PERSON COLLECTING SA LES
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO:
Part A: Storrnwater Monitoring Requirements
SAMPLE COLLECTION YEAR: g b � b
SAMPLING PERIOD:. ❑ July -December [KJanuary-June
COUNTY iUeL+J yhover
PHONE NO, (
ADD TO LISTSERVE? DYES ❑ND EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
1
NO FLOW]
pH
(Standard
Units)
TSS
(mglL)
Event
Duration
(minutes)
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 5arnpling
-
-
5-9
100213-
-
-
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, or outside the benchmark range (for pH), you must implement the Tier 1 orTier 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.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 711/2011-60/30/2015 Date of last pH meter calibration: f Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activitv Monitoring Requirements for facilities using > 55 gal of new motor oil/month --averaged over a calendar year.
Outfall
No.
Date Sample
Collected
Imo/dd/yr)'
pH
(Standard
Units)
TPH using method
1fi6AA 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]
u of Months
in Tier 2
Sampling'
6-9
15
100
-
-
-
-
I
HA5 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 aeriod
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 S1MAY THIS CFRTIFICAR0 FO(i 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 awa%e than there areAignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date: 7/1/2011-60/30/2015
(Date)
Last Revised 7/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N0. NCG14 0 Q 6 Z
FACILITY NAME: r` yX &I V lqc 0 — —
PERSON COLLECTING SAMPL
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO,.
Part A: Stormwater Monitorine Requirements
SAMPLE COLLECTION YEAR: 0?G I
SAMPLING PERIOD: ® July -December ❑ January -June
COUNTY M e W Q %) e 4--
PHONE NO. (- {a } 7"-t (o - 3 q fa
ADD TO LISTSERVE? [DYES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout []Other
OutfaU No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
Units)
Units)
TSS
(mg/L)
Event
Duration
[minutes]
Total `
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
-
-
6.9
100 '
-
-
-
-
1
viz 0
JJ EC I
20}7
C'.�hfrr.
i
DWR cc
�.►-ICES I
" fvj
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 TS5 benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 me.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-50/30/2015
I 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/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)'
pH
(Standard
units }
TPH using method
1664A SGT-HEM
(m L
�)
Total Suspended
Solids
rnL
( g/)
Event
Duration
(minutes)
minutes
Total
a
Rainfall
(in)
New Motor Oil
usage
(gal/month )
In Tier2
Monthly
Monitoring?
(y/n)
a of Months
in Tier 2
Sam ling2
p
6-9
15 2lBoy"
-
-
-
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 Quallty
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFIC4TION F2R ANY II FQRMA77ON 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."
)0 x /07ZZZ2617
ISignature of Permitte ! (Date)
Permit Date: 7/1/2011-60/30/2015 East Revised 7/13/11
Page 2 of 2

� � c
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 CO
FACILITY NAME: -25 t4 A n Ie C`
PERSON COLLECTING SAMPLE
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 1 rj / 7
SAMPLING PERIOD: O'j1uly-December ❑ January -June
COUNTY NeW i- OLv"e0er =-
PHONE NO.I /a 7gtQ- _?q69
ADD TO LISTSERVE? RYES ❑NO EMAIL:
DISCHARGING TO CLASS: [_]SA ❑HQW ❑PNA []Trout []Other
Outfall Na.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
PH
(standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Ra nfaW
(in)
In Tier 2
Monthly
Monitoring?
(Y/n)
N of Months inTier
2 Sampling
LP ��i�SI
_iv nrtit_ rit_t
Arr_'Y @r•r''rin.i
I
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.
1 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.
Permit Date: 7/l/2011-50/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > SS gal of new motor oil/month — averaged over a calendar year.
Clutfall
No.
Date Sample
Collected
(mo/dd/yr)r
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
Sampling:
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 coov of this DMR (including all "No Flow" & "No Discharge" reportsl within 30 days _of �t_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 CERTIFICATIO E0 ANY! F RMAT7ON REPORTED:
"1 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 Si nificant penalties 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