NCG140215_DMR_20221205

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(SDO) - Semi -Annual MONITORING FORM
- GENERAL PERMIT • NCG140000
CERTIFICATE OF CCAVERAGE No. NCG14 0 I- E 5
FACILITY NAME:
PERSON COLLECTING AMPLES
CERTIFIED LABORATORY Lab #
Lab #
CsPTIORZAL INFO:
Part A. Stormwater Monitoring Req
Date Sample
Qutfall No. Collected
(mo/dd/yr OR
NO FLOW1I
i & 3J-ZZ
SAMPLE COLLECTION Y
SAMPLING .kRI July -December E] January -June
COLIN1Y ✓ice'".
PHONE NO, { ) 57 5
ADD TO LISTSERVE? [DYES E]NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HO �pNA ❑TrmuY
[]OYher
pHjT,
{Standard
Total
In Tier 2
Units)
Rainfall'
Monthly
(in)
Monitoring?
(y/n)
.-7
y
?
# of Months in Tier
2 Sampiing2
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE"
2 for each outfall here. Please make sure to mark ove. the sample period ab
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range. 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
3 TSS benchmark values are 100 mg/i, except when discharging to ORW, HQW, Trout, and PNA waters where they are S0 mg/I.
° For each sampled measurable storm event the total precipitatlon must be recorded using data from an en -site rain gauge.
Permit Date: 7/l/2011-60/30/2015
Last Revised 7/13/11
/1.��_ 2—� Page 1 of 2
Date of last pH mete;;- calibration:

Part B: Vehicle Maintenance
i2uifall Date Sample
No. Collected
Acfhrty Monitoring% Requirements for facilities using > 55
pH TPH using method TOM Suspended
fStanda�rd 1664A SGT-HEM
f m g/Lj (mg/L)
15 - 9
gal of Haug motor oil/raanth —averaged over a calendar
Event Total
New Motor 01iUnits)
Duration Rainfall°
minutes Usage { ) (rI (gallmonthj
year.
In Tier TSolids
Fi�ontlll°{
h�onitarinn
(Y/njampling
M¢+►ths(rno/ddJyr}
Tier �26'9
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDEN AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)?
HAVE YOU CONTACTED THE REGION? YES [] NO
REGIONAL OFFICE CONTACT NAME:
[]
in case of "No Flow") to:
Division of Water Quality
Ann, DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
0
YES [] NO
YOU MUST SIGN IRIS CER17FIC.4TI0id fOR ANY IIUF Rli9ATIO1Vl REPORTED:
"I certify, unde enalry of law, that this document and all attachments were prepared under
my assure that all ed rsonn perly gather and evaluate the information submitted_ Based odimct'nnw r supervision in accordance with a system designed to
those perso s d[ ec fy esp nsibl f athering the information, the information submitted is, to the best of my knowledge and belief, true accurate,
Y e q f of the person or persons who manage the system, t
am aware at er e si nifi p bmitting false information, including the possibili
ry of fines and imprisonment for knowing v o violations."
complete.
(Signature f Permittee) i
bate)
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
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