NCG140106_DMR_20210106

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVE AGE N0. CG//14Q / D
FACILITY NAME: rJ do6
PERSON COLLECTING S MPLES
CERTIFIED LABORATORY Lab If
OPTIONAL INFO:
SAMPLE COLLECTION YEAR: a' 0.
SAMPLING PERIOD: ❑ July -December ❑ January -June
COUNTY Crc.vvi✓
PHONE NO. (USa-) �/ -2- 1-3 5-el
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ]Trout [_]Other
f
Part A: 5tormwater
Outfall No.
Mongonng Kequgemenco
Date Sample
Collected
(mo/dd/yr OR
1
NO FLOW)
PH
(Standard
Units)
-
TSS
(mg/L)
went
Duration
(minutes]
Total
Rainfall4
(in)
In Tier 2
Monthly
y
Monitoring?
(y/n)
# of Months in Tier
2 SamplingZ
6.92
100.3
-
-
r If "NO FLOW" or' NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outtall here. pease maKe nwe w 111di K L„C >011lr,� ram, lww
' 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/l.
4 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
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Date of last pH meter calibration:

oftet a• veaid-Ee nnni„tannnro nrtivitw Mnnitnrino Ramairpnlpntc fnr facilities using > SS 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
(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 x
:
Sampling
15
100 2,3-
-
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 com 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: OWQ 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 submitt d. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information sub itted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware_th4 there arp significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee)
Permit Date: 7/1/2011-60/30/201S
6 rc2
(Date)
Last Revised 7/13/11
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