NCG140215_DMR_20220422 (1)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COY)YtAGE NO. NCG1 0 2 �
FACILITY NAME:
PERSON COLLECTING S MPL S
CERTIFIED LABORATORY Lab #
OPTIONAL IN FO:
Part A: Stormwater Monitoring Reouirements
SAMPLE COLLECTION YEAR:
SAMPLIN ERIO JulyDecember January -June
COLIN ✓z�L�. 1
PHONE O,`
ADD TO LISTSERVE? ❑YES NO EMAIL:
DISCHARGING TO CLASS: QSA ❑HQW ❑PNA [_]Trout Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW )t
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total <
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
k of Months in Tier
2 Sampling z
-
-
6-9z
100yr—
-
-
-
-
zy, Zv
v
Ott
Cloy i RAL _
NES
1 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.
z 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/l, 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 usingdatafrom an on -site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Date of last pH meter calibration: r 1 Last Revised 7/13/11
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r.rri ITM►rAn"Wi4wV-1m
r0l L o. VCHMIC
1VJd1"ienance taciiwry nnonll
ring Kequirements for
facilities using > SS gal of new motor oil/month — averaged over a calendar
year.
Dutfall
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
Rainfall°
(in)
New Motor Oil
Usage
(gal/month)
In Tier
Monthlyin
Monitoring?
(y/n)
# of Months
Tier 2
Sampling'
6-9
15
100
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 (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") 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:
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
assufte
d p onnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
thosI esponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am a re si ' ' nt penalties for submitting false information, including the possibility f ines ang imprisonment for knowing violations."
(Signkuve of Pe i ee) ! (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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