NCG140382 DMR SW

STORMINATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N.O. NCG14 O 3 $ 2 -
FACILITY NAME: C_Apcc-WA 7i4Aa? MiYL K%AZ4 Askura.c.t t LA.4c
PERSON COLLECTING SAMPLES 'TROY SNetsvz
CERTIFIED LABORATORY PASst ArAai—rllcaIL- Lab #
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2-015
SAMPLING PERIOD: [July -December ❑ January -June
COUNTY 1AArm50.->
PHONE NO. (CoZZ) 7_3L — y 70O
ADD TO LISTSERVE? DYES [-]NO EMAIL: pp
DISCHARGING TO CLASS: OSA DHQW �PNA Trout Other D
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
pH TSS Event Total
(Standard Duration Rainfall°
Units) (m g/L) (minutes) (in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 SamplingZ
-
-
11
CiooT P4 Tsc ft Li tgp 1.39
(1
I
If "NO FLOW" or "NO
IF ,1.
DISCHARGE, Enter "NO
FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark
the samnlP narinrl
ahrniP
a value a II I excess ur ine 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.
a 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

o. it ti; o„ nnn;n+nnnnrp 4rtivity Monitoring Requirements for facilities using > 55 gal of new motor
ra1Lu. vc.n...... -
pH
Outfall Date Sample (Standard
No. Collected Units)
(mo/dd/yr)1
6-9
-
TPH using method
1664A SGT -HEM
(mg/L)
15
Total Suspended Event
Solids Duration
(mg/L) (minutes)
oil/month — averaged over a calendar year.
Total New. -Motor Oil
In Tier 2 # of Months
Monthly
Rainfall Usage in Tier 2
Monitoring? Sam lin Z
(in) (gal/month) [y/n)
P g
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)?
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
YES ❑ NO ❑
Mail Original and one co of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample or at end of monitorin eriod
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 Aectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
Eaa tha h significan�penalt�iiesfor ubmitting false information, including the possibility of fines and imprisonment for knowing violations."
�? �
(Signature of Per tee) (Date)
i
Last Revised 7/13/11
Permit Date: 7/1/2011-60/30/2015 Page 2 of 2