HomeMy WebLinkAboutNCG140076 DMR SWSTORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14- U v '7
FACILITY NAME: 1-13fi' 9-c ��`4"t 3
PERSON COLLECTING SAMPLESBe- < <
CERTIFIED LABORATORY Pa Lab # CN
Lab #
OPTIONAL INFO:
SAMPLE COLLECTION YEAR: c-) I S�
SAMPLING PERIOD: ❑ July -December anuary-June
COUNTY 0,10e- e—
PHONE NO. ( oll I ) -7 S Z--
ADD TO LISTSERVE? []YES ❑NO EMAIL:
DISCHARGING TO CLASS: []SA ❑HQW ❑PNA []Trout []Other
Part A: Stormwalier ivionixoreng nequilClplcl u
- bate Sample --
Collected pH TSS
Outfall No." ( Standard
(mo/dd/yr OR Units} (mg/L)
NO FLOW)
6-9 100",
Event
Duration
(minutes)
Total 4
Rainfall
(in) �
to Tie 2
Monthly
Monitoring?
(Y/n)
# of Months in Tier
s
2 Sampling
ME 2
CENTRAL
L)WR SE '
t If "NO FLOW" or' NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to marK the sample penoo auove.
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 50 mg/l.
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge.
W
1®
2015
-ILES
60N
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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Dart R• Vohirlo Maintonanee Artivitv Monitorine Requirements for facilities usine > 55 sal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)'
pH
(Standard
Units)
6-9 215
TPH using method
1664A SGT -HEM
(mg/L)
Total Suspended
Solids
(mg/L)
100 ,
Event
Duration
(minutes)
-
Total
a
Rainfall
(in)
-
New Motor Oil In Tier 2 # of Months
Monthly
Usage in Tier 2
(gal/month) Monitoring? Sampling2
(Y/n)
- - -
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDEN 5 AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Orieinal and one copy of this DMR (including all "No Flow" & "No Discharge" reportswithin 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. I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
(Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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