NCG140107_DMR_20220112

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NQ. NCG140000
�J Y RECEIVFI)
CERTIFICATE OF COVERAGE N0. CG14 �� Q L
SAMPLE COLLECTION
FACILITY NAME: � SAMPLING P RIOD• lulyDecember El January -June
PERSON COLLECTINGSAMPLES COUNTY CENTRAL CERTIFIED LABORATORY Lab # PHONENO � ) — t� DWR 8 L FILES
Lab # ADD TO LISTSERVE? YES []NO EMAIL: ECTIQN
OPTIONAL INFO: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout []Other
—
Part A• Ste rmwater Monitoring Rom drampntc
.........._.........�...._...._......._
Outfall No.
I _.. _..._..—
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)t
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
o
Rainfall
(in)
_
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
-
-
6.92
3U0'
-
-
-
-
i J
' 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.
' TSS benchmark values are 100 mg/I, except when dischanQng 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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Part 13: Vehicle Maintenance Activity Monitoring Reauirements for facilities using > 55 eat of new motor ail/month — averaQed evpr a ralondar vpar
Outfall
No.
Date Sample
Collected I
(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)
2 Tier
!n InTieri#
Monthly
Monitoring?
(y/n)
of Months
in Tier 2
Sampling2
6-9
' 1Sz
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 f including all "No Flow" & "No Discharge" reportslwithin 30 days of receipt of sample for at end of monitorine period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1627 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
N 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)9e signififant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature'of Permfttee) v v
(Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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