NCG140425 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140 9 Z 5, A /
FACILITY NAME: F. %tE m RaWAI -� W. �f6M)N
PERSON COLLECTING SAMPLES 06Xr;g -r2f —
CERTIFIED LABORATORY OF/SM 4M_ Lab # 4OZ-
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
RECEIVED
SAMPLE COLLECTION YEAR: Z015-- NOV 16 2015
SAMPLING PERIOD: ® July -December ❑ January -June CENTRAL FILES
COUNTY tjk)lrC DWR SECTION
PHONE NO.( e?# )_ 5 -IL -7077
ADD TO LISTSERVE? [—]YES PNO EMAIL:
DISCHARGING TO CLASS: OSA ❑HQW ❑PNA ❑Trout ❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall°
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
-
-
6-9
100"
-
-
7
1.4
20
.5
Y)
Al R-
- It "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
Z 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, 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.
PH
Date Sample
(Standard
Collected1 Units)
(mo/dd/yr)
6-9
TPH using method
1664A SGT -HEM
(mg/L)
15
Total Suspended Event
Solids Duration
(mg/L) (minutes)
100" -
Total New Motor Oil In Tier 2 # of Months
a Monthly
Rainfall Usage in Tier 2
(in) (gal/month) Monitoring? Sampling2
(y/n)
- - - -
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" reoorts) within 30 days of receiot 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 perso s directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am awar t there ar signi icant penalties for submitting fa4 information, including the possibility of fines andimprisonment for knowing violations."
Permittee)
Permit Date: 7/1/2011-60/30/2015
(Date)
Last Revised 7/13/11
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