NCG140106 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 U L o --(e-
FACILITY NAME: Raxoy Mire) &i e -e7 ' 10
PERSON COLLECTING SAMPLES
Lab #
CERTIFIED LABORATORY`
OPTIONAL INFO:
Lab i
RECEIVED
SAMPLE COLLECTION YEAR: Zo1S JUL 13 2015
SAMPLING PERIOD: ❑ July -December *anua4WRAL FILES
COUNTYSWR SECTION
PHONE NO. (Z514L+7- 5 1F,&
ADD TO LISTSERVE7 ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout []Other
Part A: Stormwater Monitoring Requirements
Date SampleIn
Collected PH TSS
Outfall No. (mo/dd/yr OR {Standard (mg/L)
Units)
NO FLOW)'
Event
Duration
(minutes)
Total
a
Rainfal{
(inl
Tier 2
Monthly
Monitoring?
(y/n)
q of Months in tier
2 Samplingz
_ -
6.9 100
I If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outtall here. Please maKe sure to marK the sampie periuu auuve.
1 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 50 mg/I.
For each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge.
Last Revised 7J13/11
Permit Date: 7/1/2011-60/30/2015
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Part R- Vahielp Maintenance Activitv Monitoring Reouirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
pH TPH using method Total Suspended
Date Sample
(Standard 1664A SGT -HEM Solids
Collected
(mo/dd/yr)i Units) (mg/L) (mg/L)
6-9 215 100 ,
Event Total New Motor Oil In Tier 2 R of Months
a Monthly
Duration Rainfall Usage in Tier 2
Monitoring? 2
(minutes) (in) (gal/month) (y/n) Sampling
- - - -
I
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 copv 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 aware at erre significant pe llieSf or submitting false information, including the possibility of find iri prisonment for knowing violations."
(Signature of Permittee) ! (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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