NCG140124 DMR SW (3)

STORM:WATER DISCHARGE OUTFA L is6) -:Semi-Annual` MONITORI'NGTORM "-
GENERAL PERMIT NO. NCG140000
RECEIVED:
SAMPLE COLLECTION YEAR:
CERTIFICATE -OF COVERAGE,NO.-NC 14�r JAN 12 2015
[:/l'�C%D�� ; SAMPLING PERIOD.1;uly-December January -June
FACILITY NAME:'
CENTRAL FILES
PERSON COLLECTING SAMP
�r�IS-1 DV!/R SECTION -
CERTIFIED LABORATORY �'�� Lab #- PHONE NO. (%)
D TO LISTS
' `,' AD ERVE? -YES NO EMAIL
Lab #
OPTIONAL INFO: - DISCHARGING TO CLASS: QSA- QHQW QPNA, ❑Trout, ❑Other
Part A: Stormwater'Monitoring Requirements
Date Sample : _. ; ., _ _ In Tier 2 ,
H Event Total
,.. Collected..... p . TSS a Monthly # of Months iri Tier
( and Duration Rainfall z
Outfall No. Stand
g?
(mo/dd/yr OR a Monitorin 2 Sam h
,.
'Units), (mg/L) ', minutes ('n)
NO FLOW} ) ( ) ;.. id
±
6=92 ::
21
1002 s
_
Tf
1 If "NO FLOW" 'or NO DISCHARGE; Enter' NO'FLbW "or rN0!1 ISNARGE- fdr,eacl~i outfall'here: Pleasetmake-sure=to markthe sample period above.
z If a value is in excess of the' benchrhark,`6r-,oLits ide th ben ch`hiark range7(for pH),�i yo u'mu0i.mplement;the Tier,1 or.Tiee-1 responsesAn the -General Permit. Tier 2,:: ,
Monthly sampling shall be done until,3 consecutive samples are. below the.benchmark or within the,benchmark range. ,
a 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 totalprecipitation must be recorded using data from an on-site rain gauge.-7-
Permit
auge.
Permit Date': 7_/1/201'V60/'30/2015 Last.Revised•7/13/11:
Page 1 of 2

F!artx3: Vehicle Maintenance Activity Monitoring Kequ|rennent tor tacm,�msusmg > 55.galornew motor oV/nmonxh-averageuover ocaienmar�yqox
HAS YOUR FACILITY HAD 4ORMORE BENCHMARK- � ' EDE CESATANYUNEUUTFA L7(, _'[UNGVEU|CLEMAINTENANCE)? YtS N&EI
-HAVE YOU CONTACTED THE REGION? YES! F]NOF]
REGIONAL OFFICE CONTACT NAME: �
Mail Original and one copy o . f this DIVIR (including I all "No Flow" & "No Discha rge"reports) within 30 days,of receipt of sample or at erfd of monit6ring period
Division of Water Quality
Attn: uvvvuomm n/c`
16 .
'
l7W1aii3e/v�e[enter .
.
Raleigh North Carolina 276991617
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 w.ho.managd the -system, or,
those persons directly responsible for- gathering the information, the information submitted Js, to the best, of my knowledge and -belief, true, ac'cumt,e,-.and,.cor-npIete. .1"
am myare that there are significant penalties for- submitting fa Ise information, ind uding the possibility pf j i nes a nd imprisonment f or,knowing vio.latib,ns.'.'..
(Signature of Permittee) (Pate)
Permit Date:'7/l/2011-60/30/2015 -Last Revised .7/13/i 1
Page 2 of 2
'
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uration
ainfall—,
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in -Tiet
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15
HAS YOUR FACILITY HAD 4ORMORE BENCHMARK- � ' EDE CESATANYUNEUUTFA L7(, _'[UNGVEU|CLEMAINTENANCE)? YtS N&EI
-HAVE YOU CONTACTED THE REGION? YES! F]NOF]
REGIONAL OFFICE CONTACT NAME: �
Mail Original and one copy o . f this DIVIR (including I all "No Flow" & "No Discha rge"reports) within 30 days,of receipt of sample or at erfd of monit6ring period
Division of Water Quality
Attn: uvvvuomm n/c`
16 .
'
l7W1aii3e/v�e[enter .
.
Raleigh North Carolina 276991617
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 w.ho.managd the -system, or,
those persons directly responsible for- gathering the information, the information submitted Js, to the best, of my knowledge and -belief, true, ac'cumt,e,-.and,.cor-npIete. .1"
am myare that there are significant penalties for- submitting fa Ise information, ind uding the possibility pf j i nes a nd imprisonment f or,knowing vio.latib,ns.'.'..
(Signature of Permittee) (Pate)
Permit Date:'7/l/2011-60/30/2015 -Last Revised .7/13/i 1
Page 2 of 2
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