NCG140001 DMR SW (6)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140001 SAMPLE COLLECTION YEAR: 2015 RECEIVED
FACILITY NAME: Thomas Concrete of Carolina -Raleigh Plant_ SAMPLING PERIOD: ® July -December ❑ January -June SEP 17 ?M5
PERSON COLLECTING SAMPLES NA COUNTY Wake CENTRAL FILES
CERTIFIED LABORATORY ESC Lab # ENV 375 PHONE NO. [phone] pr�-,y SECTIOND
4✓Yrl
Lab #
OPTIONAL INFO: August Monitoring Event
Part A: Stormwater Monitoring Requirements
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
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.
ADD TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: [:]SA ®HQW ❑PNA ❑Trout
❑Other
Outfall No
Date Sample
Collected
(mo/dd/yr OR
NOFLOW) , .
H
P .
(Stand
Urnts rd
• )
TSS
m
(`
Event
Duration
(minutes)
Total
4
Rainfall
(in )
In Tier 2
Monthly _
Monitoring?
(Y/n)
# of Months in Tier
z
2Sampling
6-9 .
23
100 '
001
No Discharge
y
17
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
Permit Date: 7/1/2011-60/30/2015
Tier 2
Last Revised 7/13/11
Page 1 of 2

.Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar vear
Outfall
No.
Date Sample
Collected
(mo/dd/yr)1
PH
(Standard
Units)i
TPH using method
1664A SGT -HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall°
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months,
in Tier 2
SamplingZ
6-9 „
15
100 '
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 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
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
£I G 9/9/2015
(Signature of Permittee) 0 (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2