NCG020689_MONITORING INFO_20170403

MR D
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
Li HISTORICAL FILE
,.9MONITORING REPORTS
D06 DATE
❑
YYYYMMDD

I lul) /h,k &k�c
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
IV C& OD y 75
DOC TYPE
Er'HISTORICALFILE
0 MONITORING REPORTS
D06 DATE
p a �� � � y 0
YYYYMMDD

I ANNUAL SUMMARY DMR - STORMWATER I
SEND TO CENTRAL OFFICE
STORMWATER DISCHARGE OUTFALLS (SDO) CEIVED
GENERAL PERMIT NO. NCG020000 - APR .0 3 101I
*Report ALL STORMWATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit ViolatiorCk l# J�each year.
CERTIFICATE OF COVE"Gg
NO. NCG02 0 6e-
SAMPLE CR LECTION YE R:
FACILITY NAME: U
r
COUNTY
PERSON COLLECTING SAMPLE
PHONE NO.
CERTIFIED LABORATOR
✓A, Lab #
ADD TO LISTERVE? YES Lj
NO U EMAIL:
Lab #
TOTALRAINFALL:- -"
INCHES
EVENT DURATION:
MINUTES
Part A: Stormwater Monitorinz Re uirements
Outfall No.
Date Sample
Collected
(mo/ddlyr OR
NO FLOW)
In Tier 2
Monthly
Monitoring?
(yln)
# of Months in
Tier 2
Sampling Z
Total Flow
(MG)
Total Suspended
Solids
(mg/1)(NTU)
Turbidity
Settleable Solids
(mlll)
-
-
-
-
100-1-4
See Footnote '
0.1
l,
Ft
Z.-3j
zL
Liz
�L /«
�7 � 2,L-
All
'If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for 6ch outfall here and the Date Range.
2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
a If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit.
° TSS benchmark values are 100 mg/l except in ORW, HWQ, trout, and PNA waters where they are 50 mgll.
5 The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservoirs designated
as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/l/2010-t2/31/2014 Last Revised 01-19-10
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Part B. Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil month on average
No O.
No.
Date Sample
Collected.
(mo/dd/yr OR
NO FLOW)'
In Tier 2
Monthly
Monitoring?
(y/n)
of Months
in Tier 2Z
Sampling.
New Motor Oil
Usage .
(gal/month)
Total Flow
(MG)
TPH using .
method 1664A
SGT-HEM
m Il
Total Suspended
Solids,
(mg/1)
pH,
(Standard
Units)
-
-
153100
6-9
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEENDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH 1 OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOUMUST 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 submitttd. 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."
3-:2-2- .r 7
(Date)
Permit Date: 1/l/2010-12/31/2014
Last Revised 01-19A 0
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