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HomeMy WebLinkAboutNCG140423 DMR SWC STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM GENERAL PERMIT NO. NCG140000 CERTIFICATE OF COVERAGE NO. NCG147v- 4 Z 3 FACILITY NAME: fora.44%, R'l PERSON COLLECTING SAMPLES _ G;� nbe to CERTIFIED LABORATORY Lab # `,Lab # OPTIONAL INFO: SAMPLE COLLECTION YEAR: 7-014 SAMPLING PERIOD: �Tuly-December [3 January -June COUNTY Fey s.�-{-►, PHONE N0. (� 1 _ q6q - Otis ADD TO LISTSERVE? AYES [:]NO EMAIL: DISCHARGING TO CLASS: [_]SA ❑HQW MPNA []Trout Other 0 - Part A: Stormwater Monitoring Requirements Date Sample Collected pH TSS Event Total In Tier 2 Outfall No. (mo/dd/yr OR (Standard (mg/L) Duration Rainfall° Monthly # of Months inTier NO FLOW)' Units) ( (minutes) (in) Monitoring? 2 Sampling �— - oLi6-9 100 - (Y/n) ' 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. 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 So 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 RECEIVED JAN 2 3 2015 CENTR4L FILES DWR SECTION Last Revised 7/13/11 Page 1 of 2 Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year. Part B: Vehicle Maintenance PH TPH using method Total Suspended Event In Tier 2 # of Months Total New Motor Oil Monthly If MoTie2 Outfall Date Sample 6664A $GT --HEM Solids Duration Rainfall° Usage Monitoring? : (in) (gat/month) Sampling No. Collected Units) (n+g/L) (mg/L) (minutes) (y/n) (mo/dd/yr)1 . 6-9 15 ' 100 - - - - HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXIEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES []NO [� HAVE YOU CONTACTED THE REGION? YES ❑ a0 Q' REGIONAL OFFICE CONTACT NAME: Mail Original and one copy of this DMR (inciudingall "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 Mall 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 aware that there are significant penalties for submitting false Information, including the possibility of fines an Imprisonment for knowing violations." fsler66re of Permi ) (Date) v Last Revised 7/13/11 Permit Date: 7/1/2011-60/30/2015 Page 2 of 2