NCG140112 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14_d / I _Z
FACILITY NAME: �!.
PERSON COLLECTING SAMPLES 4A 40A N"`'%
CERTIFIED LABORATORY E /'onrp eHf' Lizlaab # /
-��Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 201-
SAMPLING PERIOD: ❑ July -December wrSignuary-June
COUNTY M4*6 ^
PHONE NO. (Z-Vj
ADD TO LISTSERVE? ❑YES NW EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other,
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
pH
(Standard
Units)
T55
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
-
-
6-9
100 '
-
-
-
-
G ?G
.t
•ty
IA
' 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/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 using data from an on -site rain gauge.
RECEIVED
JUL 13 2015
CENTRAL FILES
DWR SECTION,
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)1
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
z
Sampling
6-9
15
100 '
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDEqp&AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO?--
HAVE YOU CONTACTED THE REGION? YES ❑ NOX
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (includine all "No Flow" & "No Discharee" reports) within 30 days of receipt of sample (or at end of monitorins 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 qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those per ons it y esponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aw that t are significant enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
07 /o /S
(Sig ture of rmittee) (Dat
Permit Date:7/1/2011-60/30/2015
Last Revised 7/13/11
Page 2 of 2

Elwuhm@[W alp hmpomUd
P.O. BOX 7085, 114 OAKMONT DRIVE
GREENVILLE, N.C. 27835-7085
READY MI% CONCRETE (WILLIAMSTON)
MR. MIKE ODOM
1020 E. 5TH ST.
WASHINGTON ,NC 27889
PARAMETERS
PH (not to be used for reporting)
Total Suspended Residue, mg/l
Stormwater Analysis Method
Discharge Date Analyst Code
8.1 06/26/15 TRB 4500HB-00
<2.8 06/29/15 KKF 254OD-97
Drinking Water ID: 37715
Wastewater ID: 10
PHONE [phone]
FAX [phone]
ID#: 1095
DATE COLLECTED: 06/26/15
DATE REPORTED : 06/29/15
REVIEWED BY: