NCG140135 DMR SW

yr
STORe!/!WATEF, DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM:,
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N0. NCG14 0 1 3 S
FACILITY NAME: AyU1,5X
PERSON COLLECTING SAMPLES laS
CERTIFIED LABORATORY&,�0144WU­77 I Lab It to4Z
Lab #
OPTIONAL INFO:
P rt A St r—ter Monitorin Requirements
2aj 56- 1
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: F July -December nuary-June
'0jt
COUNTY 951
PHONE N0. (41a) 34VI
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: [:]SA ❑HQW ❑PNA [—]Trout ❑Other
a o g
Date Sample
Collected
Outfall No.
(mo/dd/yr OR
t
NO FLOW)
PH
(Standard
Units}
TSS
(mg/L)
Event
Dura on
(minutes}
In Tier 2
Total
, Monthly
Rainfallti
Monitoring?
(in) (y/n
# of Months in Tier
2 Samplingz
- -
6-9z
100 2,3
-
J C
-
11-141
-22 2015
SECTION
E)WR
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sampie period apove.
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. 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/1, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
° 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 new motor oil/month — averaged over a calendar year.
pH
Outfall Date Sample (Standard
No. Collected
(mo/dd/yr)' Units)
TPH using method
1664A SGT -HEM
[mg/L)
Total Suspended Event
Solids Duration
(mg/L) (minutes)
Total New Motor Oil In Fier 2 It of Months
Rainfall° Usage Monthly in Tier 2
Monitoring? 2
(in) (gal/month) (y/n) Sampling
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 monitorine Deriod
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 a are that ere ar ignifi ant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee (Date)
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
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