NCG020221 DMR SW

I ANNUAL SUMMARY DMR - STORMWATER I
II SEND TO CENTRAL OFFICE * II
STORMWA TER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
*Report ALL STORMWA TER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year.
CERTIFICATE OF COVERAGE NO. NCG02� _ 1
FACILITY NAME: hir0K1 [ K .,Nl.a/5
PERSON COLLECTING SAMPLES T)it.i To,✓/r 5
CERTIFIED LABORATORY PA c8r Lab # 140
Lab #
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: Ao l l-1
COUNTY AAIS 0A,'
PHONE NO. (tZ91) 60-38-V)
ADD TO LISTSERVE? YES ❑ NO Ll EMAIL:
RECEIVED
FEB 12 2015
CENTRAL FILES
Outfall
No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in
Tier 2
Sampline
Total Flow
(MG)
Total Suspended
Solids
(mg/1)
Turbidity4
(NTU)
Settleable
Solids (ml/1)
Total
Rainfall
(in)
Event
Duration
(minutes)
-
-
-
-
-
100-1,4See
Footnote
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' If "NO FLOW' or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range.
2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 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.
TSS benchmark values are 100 mg/l except in ORW, HWQ, trout, and PNA waters where they are 50 mg/I.
'The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservoirs designated
as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1 / 1 /2010-12/31 /2014 Last Revised 0 1 -21 -11
Page 1 of 2

Part B: Vehicle Maintenance Activitv Monitoring Reauirements for facilities using > 55 eal of new motor oil/month on averaee
Outfall
No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
In Tier 2
Monthly
Monitoring?
WTI)
# of Months
in Tier 2
New Motor
Oil Usage
al/month
Total Flow
(MG)
TPH using method
1664A SGT -HEM
m
Total Suspended pH Total Event
Solids (Standard Rainfall Duration
Units in minutes
-
-
15
15
100 6-9
vo4
2 ;,qj
/1/
ey,
0�
9
g�ry
c5
�v
6 v
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [:]NON
HAVE YOU CONTACTED THE REGION? YES ❑ NO
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW', "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH I OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANYINFORMA TION 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 Imes and imprisonment for knowing
violations."
(Signaturof Permittee)
Permit Date: 1/ 1 /2010-12/31/2014
A LS
(Date
Last Revised 0l -21-1 I
Page 2 of 2