NCG020869 DMR SW (2)

I ANNUAL SUMMARY DMR - STORMWATER N
11 SEND TO CENTRAL OFFICE * II
STORMWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
*Report ALL STORMWATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH / of each ye//ar.
CERTIFICATE OF COVERAGE NO. NCG02 % 9 SAMPLE COLLECTION YEAR: o1b (if
FACILITY NAME: t4 �- ^'� ^ = (I - K,.-- DO �� COUNTY KO O c—
PERSON COLLECTING SAMPLES A PHONE NO. (7A!j) d2q — S30 q r
CERTIFIED LABORATORY Lab # ADD TO LISTSERVE? YES ❑ NO F1EMAIL: pb7 jo (A G o
Lab #
'art A: Stormwater Monitorine Requirements
Date Sample
Outfall Collected
No. (mo/dd/ r OR
y t
NO FLOW)
In Tier 2
Monthly
Monitoring?Tier
(y/n)
# of Months in
2
SamplingZ
Total Suspended a
Total Flow Turbidity
(MG) Solids (NTU)
(Mgt[)
Total Event
Settleable
Solids (ml/11)Rainfall Duration
(in) (minutes)
- -
-
-
- 1001,4 See Footnote 3,9
0.13
Tj O 0 0
43o o uJ
5
CENTRAL FILES
N
R ivv rww or Nu DiSCHARvn, nmer Nv rLVW or Nv utNt-HARGE for each outfall here and the Date Range.
Z Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 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.
° TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
'The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservoirs designated
as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/1/2010-12/31/2014 Last Revised 0 1 -2 1 -11
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Part B: Vehicle Maintenance Activit Mo Roring Re uirements for facilities using > 55 gal of new motor oil/month on average
Outfall Date Sample
No. Collected
(mo/dd/yr OR
NO FLOW)
In Tier 2 # of Months New Motor
Monthly in Tier 2 Oil Usage
Monitoring? Samplingz (gal/month)
(Y/n)
Total Flow TPH using method
(MG) 1664A SGT -HEM
(mg/1)
Total Suspended
Solids
(m )
pH Total Event
(Standard Rainfall Duration
Units) (in) (minutes)
15'
1003
6-9'
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO LrJ
HAVE YOU CONTACTED THE REGION? YES ❑ NO [�
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH 1 OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
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 that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
violations." N
(Signature of Permittee)
Permit Date: 1/ 1 /2010-12/31/2014
(Date)
Last Revised 0 1 -2 1 -11
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