NCG140302 - DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) -Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140302 SAMPLE COLLECTION YEAR: _2015
FACILITY NAME: Southern Concrete Materials -Mills River SAMPLING PERIOD: ® July -December ❑ January -June NOV 0 2 2015
PERSON COLLECTING SAMPLES _Eddie Teague COUNTY Henderson CENTRAL FILES
CERTIFIED LABORATORY ETS Lab # _600 PHONE NO. (_) DWR SECTION
Lab # ADD TO LISTSERVE? RYES ❑NO EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout ®Other
Part A: Stormwater Monitoring Requirements
Outfall No:
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)
pH
(Standard
Units )
TSS
(mg/L)
Event
Duration
{minutes)
Total
Rainfall a
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
-
-
6-92
1002.3
1
9-29-15
8.0
32
1100
2.50
N
' 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.
s 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
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for tacilities using > 55 gal of new motor oil/month — averagea over a calendar year.
HAS YOUR FACILITY HAD 4.011 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 copy 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. I
am aware that ther re signific t penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
d�
(Signature of Per it (Da e)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2
1
S
pH
TPH�usmg method.
Total Suspended
Event
4
Total
NewMotor 011
In Tier 2
# of'Months,
Outfall
Date Sample
(Standard
1664ASGT:HEM..
�,'
Solids . _
Duration .:, '
Rainfall d
, Usage � .�
Monthly
in Tier 2
No
Collected.
U its).(mg/L)
::
(minutes).Monitoring)
'� .Samplmg� R'
(y/.n)
6 9�
152
10V!3
HAS YOUR FACILITY HAD 4.011 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 copy 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. I
am aware that ther re signific t penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
d�
(Signature of Per it (Da e)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2