NCG140105_DMR_20200918

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVEMGE NO. NCG140 L i .1 SAMPLE COLLECTION YEAR: 2-0Z
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FACILITY NAME: # !c o7 014 LGC SAMPLING P�IOD: 1_44 ity-December ❑January-June
PERSON COLLECTING SAMPLES 0.a+lr� J5M.1-h COUNTY C kil t e
CERTIFIED LABORATORY Lab# PHONE NO.(63Z) 4S/-5,45-1.-
Lab# ADD TO LISTSERVE?❑YES NO EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: SA ❑HQW ❑PNA ❑Trout ❑Other
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2
pH Event Total Monthly #of Months in Tier
Collected (Standard TSS Duration Rainfall' 2
Outfall No. (mo/dd/yr OR (mg/L) Monitoring? 2 Sampling
1 Units) (minutes) (in) NM)NO FLOW)
6-92 1002 3 - RFC ��./ "P
/ , 9-,g 20 7 3 3. 0 L.(-7 �u "_
0 2T o 5 zOZa
(_.EN-1 i/'„._ r iLi;i;
DvV'R J`� . lC)N
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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,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
e) Page 1 of 2
Date of last pH meter calibration: `-��- Z

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using>55 gal of new motor oil/month—averaged over a calendar year.
In Tier 2
pH TPH using method Total Suspended Event Total New Motor Oil 4 of Months
Outfall Date Sample 4 Monthly
(Standard 1664ASGT-HEM Solids Duration Rainfall Usage in Tier 2
No. Collected Monitoring? z
(mo/dd/yr)' Units) (mg/L) (mg/L) (minutes) (in) (gal/month) (y/n) Sampling
•6-9' 15z 1002'' - - -
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDLN94 AT ANY ONE OUTFALL(INCLUDING VEHICLE MAINTENANCE)? YES E NO,'
HAVE YOU CONTACTED THE REGION? YES ❑N0
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 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 qu ip"' d •ersonnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system,or
those p o "responsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I
am aw t s -1` re significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
9'..26--zp
(Sign ture of .¢rmittee) I (Date)
Permit Date:7/1/2011-60/30/201S Last Revised 7/13/11
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