NCG140169 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) - Semi=Annual"MONITORING FORM
GENERAL PERMIT N0. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14-0— L
FACILITY NAME: mzkk
PERSON COLLECTING SAMPLES �A►a�u•.G .L►.-�er�r
CERTIFIED LABORATORY'ZZ._C_,t6k&k4,"j%-hg0 Lab # AJC- 34
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: AUL:
SAMPLING PERIOD: K July -December ❑ January -June
COUNTYCoQ S?+h
PHONE NO. (a3kj `74S`'�� �S
ADD TO LISTSERVE? RYES ❑NO EMAIL:
DISCHARGING TO CLASS: [:]SA ❑HQW ❑PNA ❑Trout
[—]Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
_
pH
(Standard -
Units) TSS
(mg/L)
In Tier 2
Event Total
, Monthly # of Months in Tier-
Duration Rainfall
" -
Monitoring? 2 Sampling2
(minutes) (in) (y/n)
-
-
6-92 100 ,3
- - - -
O
DEC 16 201
DWR SECTIO 4
1 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.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, 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 pH TPH using method Total Suspended Event- Total New Motor Oil
(Standard 1664A SGT -HEM Solids Duration Rainfall° Usage
CollecteddMonitoring?
(mo/dd/yr)1 Units) (mg/L) (mg/L) (minutes) (in) (gal/month)
- - - -
6-9Z 15Z" 10043
In Tier 2
# of Months
Monthly
in Tier 2
(Y/n) SamplingZ -
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 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 aware that there are sign ificant,l�enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Pe
In -� I - )_—
(Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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