NCG140015 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14- (�> O S'
FACILITY NAME: f �c�S �Zg,o p�� yyt`, �(�J(� y� -c-
PERSON
PERSON COLLECTING SAMPLES J C bcl�c,.0
CERTIFIED LABORATORY LNV'► rc, In rnc,,,a 1. Lab # /09?
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Reauirements
SAMPLE COLLECTION YEAR: �� s
SAMPLING PERIOD: ❑ July -December anuary-June
COUNTY W i+�:i <--
PHONE
PHONE NO. (tet I ci ) 0.3 U - Q KT
ADD TO LISTSERVE? ❑YES Egl1O EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout [`�ther
Date Sample
Collected
Outfall No. (mo lected/yr OR
i
NO FLOW)
PH
(Standard TSS
Units ( g/)
)
6-92 1002'3
Event
Duration
(minutes)
Total
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(Y/n)
# of Months in Tier
2 Sampling2
1 S -It -Is
r1,s I
/3s
r75
MAY
CENT
L Ell ES
uvVR SECTION
- It "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 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, HQW, 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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e,.• n.- v .1.:rle 11M:ntnn�nru ArtivLt%i Nlnnitnrina Ranniramantc fnr fnrilitiac ii -dna !* SS gal of nPw mntnr nil/mnnth — averaged ever a calendar vear
Outfall
No.
Date Samplea
Collected
(mo/dd/yr)1.
pH
(Standard
Units)
6-92
TPH using method
1664A SGT -HEM
(mg/L)
152
Total Suspended Event
-Solids Duration
(mg/L) (minutes)
1002'3 -
In Tier 2
Total New Motor Oil # of Months
Monthly
Rainfall Usage in Tier 2
(in) (gal/month) Monitoring? Sampling2
(y/n)
- - - -
i
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES []NO[:]
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 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 persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware th there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee)
Permit Date: 7/l/2011-60/30/2015
(Date)
Last Revised 7/13/11
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