NCG140124_DMR_20220517

C
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG14OOOO
CERTIFICATE OF COVERAGE NO. N G14 0 I A I
FACILITY NAME: L
SAMPLE COLLECTOR:
CERTIFIED LABORATORY Lab # J4 /
Lab #
OPTIONAL INFO: aj IIn��t.
Part A: Stormtor water Moniing Requirements
SAMPLE COLLECTION YEAR: 202 -L
SAMPLING PERIOD: ❑ July -December ® January -June
COUNTY C 6&llanel.
PHONE NO. 7( ON) q3N—(oSs�
ADD TO LISTSERVE? []YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA [—]Trout ❑Other Q
Outfall No.
Date Sample
Collected
(mm/dd/yrOR
NO FLOW)'
pH
(Standard Units)
TSS
(mg/L)
Total
Rainfall°
(in)
In Tier 2
Monthly Monitoring?
(y/n)
# of Months in Tier 2
Sampling'
-
6-92
10073
1 -
-
I
fa 1,25 1 a;t,
g
I
,53
711
0
RecEW
CENTRAL F1
ES
DWIR SECT
DI!
'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.
C 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 over a calendar year.
pH
Non -Polar
Oil `& Grease using
Total
Total
f
In Tier 2
Q_utfall
Date Sample
(Standard
method 1664
Suspended
: Rainfall'
New Motor Oil U
ge
Monthly
# of Months in Ter 2
No.
Collected
Units) .:
GT-HEM
S ,
Solids `
..
(in)
(ga1/month)
Monitoring?
Samp{ing2
(mo/dd/yr)1
(mg/L) .
(Y/n)
6-92
152
100
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE? YES ❑ NO to
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑ I
REGIONAL OFFICE CONTACT NAME:
II "No Flow" & "No Discharee" reports) within 30 days of receirk of sample (or at end of monitori
case of "No Flow") to: i
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFIG4TION 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 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 bellief, true, accurate, and complete. I am
aware hat there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Date)
Permit Date: 8/1/2017-6/30/2022
c
17
Last Revised 07/27/17
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