NCG140259 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM,,.
GENERAL PERMIT NO. NLU14000U
CERTIFICATE OF COVER GE NO. NCG14� �
FACILITY NAME: 7 t r
PERSON COLLECTING SAMPLES ko b reV1
CERTIFIED LABORATORY Wahl- TeCLI (nb, )n C Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Reauirements
RECEIVED —
SAMPLE COLLECTION YEAR: o 15 OCT TO 20!5
SAMPLING PERIOD: 5] July -December ❑ Janu Mld %AL FILES
COUNTY V1%L-IZL',d0,) DWR SECTION
PHONE NO. (J 33 -DSAS
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW '❑PNA- ❑Trout ❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW 1
PH
(Standard
Units)
TSS
(mg/L))
Event
Duration
(minutes)
Total,
Rainfall°
(in)
In Tier 2
Monthly
Monitoring?
iy/n)
# of Months in Tier
2 Sampling
-
6-9
100
-
-
-
q -a5 -is.
.5
YO
q I n
/V
N
If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW"'or NO DISCHARGE" for each outfall here Please make sure to mark the s,-Imple period above
If a value is ±n excess of the benchrTiark, 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 bencr-.mark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA ware; s where they are 50 mg/I
For each sampled rneasurable storm event the total precipitation must be recorded using data fro.rn an on-site rain gauge.
Permit Date, 7/1;'2011 60/30/2016 Last Revised 7/13/11

Part B: Veh.—f Maintenance Activity Monitoring Requirements for facilities using > 5:., odI of new motor oil/month - averaged over a calendar year.
falI
No.
Date Sample
Collected
(mo/dd/yr)'
pH
(Standard
Units)
TPH using method Total Suspended
1664A SGT -HEM Solids
(mg/L) (mg/L)
Event
Duration
(minutes)
Total
,
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
q of Months
in Tier 2
z
Sampling
6-9
15 100 27-
b' l&/1
b
A
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
am aKpre that there ire significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
(Signalpre of Permittee) (Date)
Fera iDate 7/1/2031-60/30/2016 LastReviseC /!3/1]
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