NCG140124_DMR_20191030

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N0. NCG14 0 J �, =�
FACILITYNAME: We-lh p,4Dh4o_r rtck_
SAMPLE COLLECTOR: KkLLOd Th - U I e_
CERTIFIED LABORATORYLab#� D ;?—
Lab #
OPTIONAL INFO: 'Anr ltnC1 nrthat l0. +
Part A: Stormwater Monitorihd Re6uiremefits
SAMPLE COLLECTION YEAR: A 6 1'7
SAMPLING PERIOD: ® July-Decernber ❑ January -June
COUNTY dlcUc(and
PHONE NO. LM //r3tl-6651
ADDTO LISTSERVE7 ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other C
Outfall No.
Date Sample
Collected
(mm/dd rOR
/Y 1
NO FLOW)
pH
(Standard Units)
TSS
(mg/L)
Total
Rainfall ,
(in)
in Tier 2
Monthly Monitoring)
(y/n)
# of Months in Tier 2
Sampling'
-
-
6-91
1001,3
_
-
-
Io l& Iq
N
o
RECENFEII
,ENTRAL FttES
' 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.
] 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/I.
°For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 8/1/2017-6/30/2022 Last Revised 07/27/17
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PartB: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged lover a calendar year.
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO VJ
HAVE YOU CONTACTED THE REGION? YES ❑ NO D
REGIONAL OFFICE CONTACT NAME:
Mail 0dizinal and one corw of this DMR (including all "No Flow" & "No Discharee" reports) within 30 days of recdir)t of sample (or at end of monitoring period in
case of "No Flow") to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANYINFOR ATION REPORTED:
"I certify, under penalty of law, that this document apd 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 pe sons who manage the system, or those
persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and elief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonme t for knowing violations."
_ Jo� 250-/
(Sign ture of Permittee) (Date)
Permit Date: 8/1/2017-6/30/2022 Last Revised 07/27/17
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