NCG140215_DMR_20220112

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14
FACILITY NAME: 0 A'
PERSON COLLECTING S MPLES !L -a
CERTIFIED LABORATORY FALL--- 7 L Lab # & �3 3
I_k M
OPTIONAL INFO:
RECEIVE®
SAMPLE COLLECTION YEAR: )/AN 1 /', ?0
SAMPLING P RIOD: July -December El January -June
G , F,. CENTRAL FILES
COUNTY DWR SECTION
PHONE N0. (�) ��: h- 7y7`�
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout [:]Other
—
Pan A: �IiOrmwarer
Outfall No.
NlUmrunng ncy uu cu......
Date Sample
Collected
(mo/dd/yrOR
NO FLOW)
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
<
Rainfall
(in)
—
In Tier 2
Monthly
Monitorin ?
g
(y/n)
# of Months in Tier
lip
2 Sam '
p g
_
-
6-9'
1001•3
-
-
-
-
t If "NO FLOW" or' NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outran here. pease make sure Lu nlmk t1M 5anrlp c Ner loo a. cvc.
' 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.
' For each sampled measurable storm event the total precipitation must be recorded using data from an cn-site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Date of last pH meter calibration: Last Revised 7/13/11
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Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year.
Outfail
No.
Date Sample
Collected
(mo/dd/yrf
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 2
Sampling"
6-9
is
1
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO l�
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
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 for 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 qualifi d p sonnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those pInst c y esponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aw re a significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
12,1�-z l
(Signature of Perm' ee) ! (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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