NCG140425 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14_0_q gLf
FACILITY NAME: &W14 ROCK 002M 9—Aft'h /1)AW ARP
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: ;2415
SAMPLING PE1j9DW July -December January -June
COUNTY ���ffj�
PHONE NO. (�
ADD TO LISTSERVE? RYES ❑NO EMAIL:
DISCHARGING TO CLASS: OSA ❑HQW ❑PNA ❑Trout ❑Other,
Date Sample
Collected
Outfall No.
OR
1
NO FLOW)
pH TSS
Standard
( m L)
Units) (mg/L)
In Tier 2
Event Total
a Monthly # of Months in Tier
Duration Rainfall
(minutes) (in) Monitoring? . 2 SamplingZ
(y/n)
- -
6-9 100 ,
UL
pw S
it
II IVU rLVVV UF IVU UgI,MAKUt, 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.
3 TSS benchmark values are 100 mg/l, 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: 7/1/2011-60/30/2015 Last Revised 7/13/11
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Part B: Vehicle
Outfall
No.
Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month
Date Sample pH TPH using method Total Suspended Event Total
Collected (Standard 1664A SGT -HEM Solids Duration Rainfall°
(mo/dd/yr)l Units) [mg/L) (mg/L) (minutes) (in)
6-9 15 100"'J
— averaged over a calendar year.
New Motor Oil In Tier 2 q of Months
Usage Monthly in Tier 2
(gal/month) Monitoring? lY/nl SamplingZ
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO L�
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
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 p s ns directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
amZ
re t at there are s' ificant alties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re df Permittee)
Permit Date: 7/1/2011-60/30/2015
(Date)
Last Revised 7/13/11
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