NCG140170_DMR_20220112 (1)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COV AGE N0. NCG14 O I 71
FACILITY NAME: /' ✓J
PERSON COLLECT1146 S M LES y l
CERTIFIED LABORATORY 5 ab q _
OPTIONAL INFO:
SAMPLE COLLECTION YEAR: ;re22
/
SAMPLING P D: July -December ❑ January -June
COUNTY
PHONE NO.
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ]Trout []Other
Pan A: mormwater
Outfall No.
miunn.unng, neyuu c
Date Sample
Collected
(mo/dd/yrOR
1
NO FLOW)
u,co��
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total <
Rainfall
{in)
In Tier 2
Monthly
Monitoring?
(y/n)
It of Months in Tier
7
25ampling
_
-
6.9Z
100'a
-
-
-
REC
GENT
r If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure co roam iHe bmnPM PcF Ou 3cGV
e.
' 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. 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/I.
' For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
J
L FILES
ECTION
Permit Date: 7/1/2011-60/30/2015 Date of last pH meter calibration: Last Revised 7/13/11
Page 1 of 2

Part 13: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gat of new motor oil/month — averaged over a calendar year.
Outfatl
No.
Date Sample
Collected =
(mo/dd/yrj
pH
(Standard
Units)
TPH using method
1664A SGT HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
buration
(minutes)
Total
Rainfalla
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2 Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling
6-9
15
I
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 g
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coov 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 certif, unde penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure oYiedr I properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those ppsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aws nificant enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signat6e of Permittee) - (Date)
Permit Date: 7/l/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2