NCG140135_DMR_20200925

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N0. NCG14-0 L 3 S
FACILITY NAME: iqnat6 UJI9 kJ -(-'-
PERSON COLLECTING IrAMPLEi I C� 9 1�4AQtD
CERTIFIED LABORATORY Fhylr0')Jnent 1 Lab#
OPTIONAL INFO:
i
SAMPLE COLLECTION YEAR: _
SAMPLING PERIOD: P] July -December ❑ January -June
COUNTY / JOw
PHONE NO. (y10) 2
ADD TO LISTSERVE? ❑YES ONO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HCtW ❑PNA ❑Trout []Other
Part A: SLOrmwaxer
Outfall No.
monnonng rtegmremenu
Date Sample
Collected
(mo/dd/yr OR
t
NO FLOW)
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
all
Rainf<
(in)
In Tier 2
Monthly
Y
monitoring?
(y/n)
p of Months in Tier
2 Sampling=
6.9
lOD
l
/V0 Tow
qg
%ia'vTti'
it
t If "NO FLOW" or' NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE' for each outfan here. Please make sure to mamR use sampe per L...
' 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 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: 7/1/2011.60/30/2015
Last Revised 7/13/11
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Date of last pH meter calibration: (q'-15 - ^� OX

Part B: Vehicle Maintenance Activity Monitorine Requirements for facilities using > 55 gat of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
collected
(mo/acted'
pH
(Standard
Units)
TPH using method
1664A SGT HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfallo
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2 Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
2
Sampling
6-9
1s
100
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [:]NOR
HAVE YOU CONTACTED THE REGION? YES [:]NO
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coon 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 there are signifion; penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
MlIff
MA; AWN
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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