NCG140425 DMR SW (3)

STORMWATER DISCHARGE OUTFALL QSDOD o Semi-Annua0 IMONffORNG FORM
GENERAL PERMIT NO. NCC 140000
CERTIFICATE OF COVERAGE NO. NCG140 4 2 5
FACILITY NAME: E/6X r (X Epi✓ GLC.
PERSON COLLECTING SAMPLES _V. 74)107 -
CERTIFIED LABORATORY &ISM ZAt6&476ff'CLab # _k22-
Lab
ZLab #
OPTIONAL INFO:
Part A: Stormwater Monitorine Reauirements
SAMPLE COLLECTION YEAR: 2
4
SAMPLING PERIOD:'X July -December ❑ January -June
COUNTY
PHONE NO. ( ) 7
ADD TO LISTSERVE? ❑YES KNO EMAIL:
DISCHARGING TO CLASS: [:]SA ❑HQW ❑PNA ❑Trout []Other
JAN 2 0 20`
CENTRAL FILES
DWR SECTION
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)
pH
(Standard
Units)
T55
(mg/L)
Event
Duration
(minutes)
Total
Rainfa114
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
-
6-92
1002'3
-
-
-
-
�0
20
6
i
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, HOW, Trout, and PNA waters where they are 50 mg/I.
4 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 nPVV motor nil/mnnth — a„Prnand Swann rola-4--mr
Outfall
No.
Date Sample
Collected
1
(mo/dd/yr)
pH TPH using method
(Standard 1664SGT-HEM
Units) ( mg/L) �
Total Suspended
Solids
Solids
Event
Duration
(minutes)
Total
Rainfall4
(in)
New Motor Oil In Tier 2
Usage Monthly
Monitoring?
(gal/month)
(y/n)
# of Months
in Tier 2
2
Sampling
6-92 152
1002'3
-
- -
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:
I
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 managethe sys;.em, or
those per s directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am awa th t there are nificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations .�"
(Sig ture f Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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