NCG140163_MONITORING INFO_20180305

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑HISTORICAL FILE
$MONITORING REPORTS
DOC DATE
❑ � �� D � � � 5
YYYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
❑HISTORICAL FILE
eMONITORING REPORTS
DOC DATE
❑ 2(S) (V a (9 p
YYYYMMDD

ANNUAL SUMMARY DISCHARGE MONITORING
- REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2017
*Report ALL STORMWATER monitoring data on this form (include "No Flow'?'No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG 140163
Facility Name: Southern Concrete Materials — East Plant
County: Union
Phone Number: (828 253-6421 Total no. of SDOs monitored 1
Certified Laboratory ETA Lab # 600
Lab #
Stormwater Discharge Outfall (SDO) No. 1 VMA Outfall? Yes ❑ No
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No
Was this outfall ever in Tier 2 during the past year? Yes ❑ No ZJ _
If this outfall was in Tier 2 last year, was monthly monitoring discontinued? r� �l� �1� _ n
Yes, enough consecutive samples below benchmarks to decrease frequency ❑ MAR 0 5 lu ld
Yes, received approval from DEMLR to reduce monitoring frequency ❑
CENTRAL FELL;
Other ❑ DV`JR 5rr-r-l>,,,
Outfall No.
-
Total Rainfall,
inches
Total
Suspended
Solids TSS ,
(}
m !/ I
pH,
5U
Non -polar O&G
(EPA Method
1664 ( })�
mgll (VMA} SGT-HEM
!f applicable
New Motor Oil
Usage (gallmo.)
xappllcable
Stormwater
Benchmarks
lndlcare NO FLOW If
applicable
Circle Benchmark
1 Or1150
V
6.0-9. (}
15
�55 g alfmo. average requires TSS and
Non -polar O&G monitoring
Date Sample
Collected,MMM
molddl r
06/30/2017
No flow
12/31/2017
No flow
- Permit Date 811/2017 — 6130/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG 14 0M©Q
CERTIFICATION
"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 aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
[Required by 40 CFR § 122.22)
Signature
Date 2,1)-6%/
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (not DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
_ Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 81112017 — 6130/2022
Last Revised 8-22-2015

,5TORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
' GENERAL PERMIT�NO. NCG140000
RECEIVED
CERTIFICATE OF COVERAGE NO. NCG140163
FACILITY NAME: _Southern Concrete Materials -East Plant
PERSON COLLECTING SAMPLES _Jeff Lamm
CERTIFIED LABORATORY ETS Lab # 600
Lab #
AUG 3 1 ZPSAMPLE COLLECTION YEAR: _2016
ter, i-.OAE t:1;5AMPLING PERIOD: ® July -December ❑ January -June
OPTIONAL INFO' vwa.mmn%3 irn i w -.Lmia. L_j-�m L-jn%Avv
Part A: Stormwater Monitoring Requirements
[_]
RNA ❑Trout ®Other
Outfall No.
Date Sample
Collected
{mo/dd/yr OR
NO FLOW)'
pH
{Standard
Units}
T55
{mg/L}
Event
Duration
{minutes}
Total a
Rainfall
{in}
In Tier 2
Monthly
Monitoring?
{y/n}
# of Months in Tier
2 Sampling'
-
-
642
1002.3
-
-
-
-
1
$-10-16
8.1
33
60
0.1
N
N/A
/r r
I. � �
L E
T �
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 Genera! Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
s T55 benchmark values are 100 mg/I, except when discharging to ORW, HOW, 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: 7/1/2011-64/30/2015 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}1
pH
(standard
Units)
TPH using method
1664ASGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall a
(in)
New Motor Oil
Usage
(gal/month)
in Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling 2
6-92
152
1002,3
-
-
-
-
-
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 Discharize" 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 responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are signifiMnt penaltie,§ for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
8/24/2016
(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 NO. NCG140163 SAMPLE COLLECTION YEAR: _2016
FACILITY NAME: _Southern Concrete Materials -East Plant SAMPLING PERIOD: ❑ July -December ® January -June
PERSON COLLECTING SAMPLES _Jeff Lamm COUNTY Union
CERTIFIED LABORATORY ETS Lab # 600 PHONE NO. (_}
Lab # 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
(ma/dd/yr OR
NO FLOW)'
pH
(Standard
Units]
TSS
(mg/L)
Event
Duration
(minutes]
Total n
Rainfall
(in]
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Samplingz
-
-
6-92
1002.3
-
-
1
1-15-2016
-8.76
-7.8
480-
0.9-
no-
PR TT
2016
DWR SE
'TI
' 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/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.
_
OutfaII
No.
Date Sample
Collected
(rho/dd/yr)l
PH
(Standard
Units)
TPH using method
1664A SGT-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
6-92
152
1002,3
-
-
-
-
-
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 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. I
am awareAhat therplre significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Permittee)
2/1/2016
(Date)
Permit Date:7/1/2011-60/30/2015
Last Revised 7/13/11
Page 2 of 2

-WORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT No. NCG140000 D
CERTIFICATE OF COVERAGE NO. NCG140163.,
FACILITY NAME: _Southern Concrete Materials -East Plant_
PERSON COLLECTING SAMPLES _Jeff Lamm
CERTIFIED LABORATORY ETS Lab # _600
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2016
SAMPLING PERIOD: ❑ July -December ® January -June -
COUNTY Union —
PHONE NO. ( )
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}
TS5
(mg/L)
Event
Duration
{minutes}
Total
Rainfall a
(in}
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
-
6-92
1001,3
-
-
-
-
1
1-15-2016
-8.76
-7.8
480-
0.9-
no-
RECEIVED-
FEB 08 2016
,
,_ �%
ILA
DWR SECTION
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/I, except when discharging to ORW, HOW, 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
Na.
Date Sample
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
Rainfall'
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n}
# of Months
in Tier 2
Sampling2
6-92
152
1002,1
-
-
-
-
-
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 OrlEinal and one coov of this DMR (includine all "No Flow" & "No Discharee" 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. I
am aware_1hat therg,gre significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signatdra'dt Permittee)
2/1/2016
(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 NO. NCG14 U L id
FACILITY NAME: OA
PERSON COLLECTING SAMPLES �-..�
CERTIFIED LABORATORY s--r .S Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION Y FR: (�
SAMPLING PERIOD: July -December ❑ January -June
COUNTY t,ln • Q-n
PHONE NO. (�j
ADD TO LISTSERVE? ❑YES []NO EMAIL:
DISCHARGING TO CLASS: []SA ❑HQW ❑PNA ❑Trout ❑Other,
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FL0W)'
pHEvent
(Standard
Units}
TSS
(mg/L)
Duration
{minutes)
Total
Rainfall'
{in}
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Samplingz
-
-
6-92
1002,1
1
o
MtULIVED
FILES
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 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.
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
l
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-ti
rNo.
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
Rainfall'
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
{y/n}
# of Months
in Tier 2
Sampling 2
6-92
15Z
1001,3
-
-
-
-
-
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 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 t �tthere yaregnificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
l �.
(Signatur o ermittee) (Dade)
Permit Date: 7/l/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 NO. NCG14 3) . b __� 1
FACILITY NAME: 'i_ A Y i n 4r, c I
PERSON COLLECTING SAMPLES �.
CERTIFIED LABORATORY F_�L . S Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: _ �-j
SAMPLING PERIOD: ❑ July -December January -June
COUNTY 1/� h
PHONE NO. ( )
ADD TO LISTSERVE? DYES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
Outfall No.
Date Sample Collected
(mo/dd/yr OR
NO FLOW)' O
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall o
(in)
In Tier 2
Monthly
Monitoring?
n
# of Months in Tier
2 Sampling2
-
6-9z
-
-
l'-
d
- y1002,3
/ ,
r-
J
/�
11 b / Ll
Al
+Y RAL
cT10
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, HOW, 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

Part B ~Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
:;.
Outfan..
No.
�._Date sample
Collected
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
1664A5GT-NFM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall a
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling'
6-92
1s'
1002,3
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 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: 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 ere are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature o Pe ' tee) (D e)
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 NO.UNCG14_ .
FACILITY NAME:_-L'J'Affn
PERSON COLLECTING SAMPLES TQ
CERTIFIED LABORATORY m Lab # 9 L
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION Y AR: - U ) /
SAMPLING PERIOD: [July -December ❑ January -dune
COUNTY Vn . 4 r
PHONE NO. ( )
ADD TO LISTSERVE? ❑YES NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ZOther_
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
{Standard
Units}
TSS
{mg/L}
Event I
Duration
{minutes}
Total
Rainfall'
{in}
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling'
-
6-92
1002.3 '
-
-
-
-
1
R C
CENTRA
' 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, HOW, 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.
IVED
5 2015
. FILES
CT}ON
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)1
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
Sampling 2
6-92
1S2
1002.1
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 (includine all "No Flow" & "No Discharee" reports) within 30 days of receipt of sample (or 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 that there are signAcant pena4ies 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

_:—,
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE No.ttNCG14 6 I b 3
FACILITY NAME: �. h 4.4 n C d-- e ? k
PERSON COLLECTING SAMPLES rr)-r—
CERTIFIED LABORATORY F T .S Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: J }
SAMPLINGERIOD: ❑ July -December January -June
COUNTY y1 1lr-
PHONE NO. ( )
ADD TO LISTSERVE? []YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout 00ther
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
[Standard
Units)
TS5
[mg/L]
Event
Duration
[minutes]
Total
Rainfall c
[in)
In Tier 2
Monthly
Monitoring? .
(y/n)
## of Months in Tier
2 Sampling2
-
-
6-92
1002.3
%
6
o
IfY
t—GH V —
WA
LtN I RAL FILES
mi­e.
i4V
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/I.
"For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
19
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)1
PH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspend
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall a
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2ed
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling2
6-92
15,
1002,3
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 conv 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 responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that here are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of a ttee) (D te)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2