NCG140423 DMR SW

C
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