NCG140259 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 0 _L 5 q
FACILITY NAME: em-
P/—w
PERSON COLLECTING SAMPLES D bl
CERTIFIED LABORATORY WAjtj- f&r t-Ak InC Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: b15
SAMPLING PERIOD: [] July -December [January -June
COUNTY V
PHONE NO. (� 3-Ogo1.Y
ADD TO LISTSERVE? YES nNO EMAIL:
DISCHARGING TO CLASS: []SA []HQW [-]PNA OTrout Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
,
Rainfall
(in)
In Tier 2
Monthly # of Months in Tier
Z
Monitoring? 2 Sampling
(y/ n ) ,
-
-
6-9
100 '
-
-
- -
T 00
14
KR -UHVED
FILES
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
If a value is in excess of the benchmark, or outside the be ichmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit Tier 2
tvlonthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are SO mg/I
for earh sampled measurable storm event the total precipi ation must be recorded using data irun, an on-site rain gauge
Poiwm:I)ate 7/:/;01' Fi(:r3(,'?0]6 1astPAvi.ed7/13;..

40", a W.k. , MalntPnanrP Ortivity MnnitorinP RPauirements for farilities'usine > S- _dl of new motor oil/month - averaeed over a calendar vear:
Outfall
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
Samplings -
6-9
15 100
N ; !�!�
/ f
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO W
HAVE YOU CONTACTED THE REGION? YES []NO
REGIONAL OFFICE CONTACT NAME: r
Mail Orieinal and one coov 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 aviai e t there are Si ificant'penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
(Signature of rmittee) (Date)
,e 7/1/2011-60/30/2016- L.-„
n?I;, 2 O'