NCG140147 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 d) 4 ''
FACILITY NAME: ft A, Ill a &%,e Lie C0- JP%4!d _023
PERSON COLLECTING SAMPLES L, Ibu d T;lI w •-+
CERTIFIED LABORATORY frw -* f#Kw%+r+f ) /►+GLab # / Q
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2015'
SAMPLING PERIOD• uly-December ❑ January -June
COUNTY % ,�. t
PHONE NO. (252 ) b�
ADD TO LISTSERVE? ❑YES ?%—O—EMAIL:
DISCHARGING TO CLASS: OSA ❑HQW ❑PNA ❑Trout [—]Other
RECEIVED
NOV 0 6 2015
CENTRAL FILES
SWR SECTION
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall 4
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 SamplingZ
-
-
6-9
100 ,
-
-
-
/0//7-115
I2 J6I�
2
v i2 /!_
14
2
.O
IV z S
' 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.
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.
4 TSS benchmark values are 100 mg/I, except when discharging to ORW, HOW, 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.
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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` Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected 1
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
1664A SGT -HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling2
6-9
15
100 '
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCE��ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NOyj�
HAVE YOU CONTACTED THE REGION? YES ❑ N �J
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end ofMail Original and one copy of this DMR all "No Flow" & "No reports) within 30 days of receipt of sample (or at end of monitoring
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 pers s direc
way y responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aiat thi 5"significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re of
Permit Date: 7/l/2011-60/30/2015
o�S
(Date)
Last Revised 7/13/11
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