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HomeMy WebLinkAboutNCG140423 DMR SW (2)STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM GENERAL PERMIT NO. NCG140000 CERTIFICATE OF COVERAGE NO. NCG14 D ± 1 1 FACILITY NAME: PERSON COLLECTING SAMPLES1= r� c `7, -An LcLr CERTIFIED LABORATORY -AJIL4 Lab # Lab # OPTIONAL INFO: Ulk Part A: Stormwater Monitoring Requirements SAMPLE COLLECTION YEAR: 15' f SAMPLING PERIOD: ❑ July -December January -June COUNTY J(/(, .0 6 �0�g PHONE NO. ADD TO LISTSERVE? [—]YES[]NOEMAIL: D RTS DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA [:]Troutther '� SECTION Outfall No. Date Sample Collected (mo/dd/yr OR 1 NO FLOW) pH (Standard Units) TSS m (g/L) Event Duration (minutes) Total 4 Rainfall (in) In Tier 2 Monthly Monitoring? (y/n) # of Months In Tier 2 2 Sampitng - - 6-9 100"5- - _ O ' ;1 imu rLvw or 14U UUM-MAKUE, Enter "NU I -LOW " 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. a TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l. '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 Page 1 of 2 Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > SS gal of new motor oil/month — averaged over a calendar year Outfall Date Sample pH TPH using method Total Suspended Event Total New Motor Oil In Tier 2 No. Collected (Standard 1664A SGT -HEM Solids Duration Rainfall° Usage Monthly I (mo/dd/yr)1 Units) (mg/L) (mg/L) (minutes) Monitoring? (in) (gal/month) (y/n) 6-9 15 100 ' HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEE�CES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO HAVE YOU CONTACTED THE REGION? YES ❑ NO REGIONAL OFFICE CONTACT NAME. # of Months In Tier 2 Sampling2 Mail Original and one coDv of this DMR jincluding 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 YOUMUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: THIS CERT/f1�TION 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 a e that t re ignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." nature of Per (Date) Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11 Page 2 of 2