NCG140051 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)'Serhi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140051 RCI LE COLLECTION. YEAR: 2014 .
FACILITY NAME: Gastonia LING PERIOD: ® July -December []January -June
PERSON COLLECTING SAMPLES: Scott Miller JAN 2'0 2MUNTY Gaston
CERTIFIED LABORATORY:. -Prism Lab # 402 CENT PHONE NO. (704) 372=2930
OPTIONAL INFO: DWR IAL
FILAM TO LISTSERVE?-[]YES ®NO EMAIL-
TR
MCHARGING TO CLASS; [:]SA OHQW �PNA QTrout ®Other
Part, A: Stormwater Monitoring Requirements
Outfall No
Date Sampie :
Collected
(mo/dd/yr OR: =
`.NO'FLOW)i
p H
(Standard
r, ,
`Units)..;
Event, Tofal
TSS a
;, Duration Rainfall
(mg/E) x '
(minutes) (m)
In'Tier Z
Monthly `'
Monitoring?
�,IY/n)
# of Months m Tier -
z
'2 Sampling
6-9
100
001
9/23/14. -
No Flow
i ivv r-wuv U1 ivu vw%-nr,nur, rand ivu rwvv u1 avu uiat-nrvnur ivr edcn vuLidn nere._rMdse rndrce sure tiu mdLK ane sdmpie penva douve.
2 If a.value is in excess of the benchmark, or outside the benchmark range (for pH), you _must implement the Tier 1.orTier 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.
"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

Part 6: Vehicle Maintenance Activity Monitoring Requirements for facilities using 55 gal of new motor oil/month -averaged over a calendar year.'
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANYONE OUTFALL (INCLUDING ,VEHICLE mAINTENANCE)?YES [-]"NO Z
HAVE YOU CONTACTED THE REGICINT, YES- E!"NO M
REGIONAL OFFICE CONTACT NAME: Mooresville NCDENR.
Mail Original and one copy of this DMA (iriduclin� 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 pe alty of law- that this clocument and all attachments were prepared undermy direction or'supervision in accordance with a system designed to
assure that qualifi person roperly gather and ovaluate the information, submitted. Based on,my inquiry of the person or persons who manage the system, or
those p rs ris it ctly r sible for gathering the information, the information submitted is, to the=best of my knowledge and belief, true, accurate, and complete. I
9
fi
a , r e
those
e'o under
penalties for submitting false information 1 possibility of fines -and imprisonmen . o
am th i including the possi.b t f r knowing violations."
($afZ �re of". rmltted) (Date)
Permit, Date: 7/1/2011-60/30/201.5 :Last Revised 7/13/11
Page 2 of 2
'E
'Total,
In Tier 2.
Date:, le
P H JPH'iisifig:iiieth6d ,--'-Total Suspended- vent- -1 � I
,, �­- � �Monthly
i
of Months
amo
(Standard'.,
�F-'
1664A SGT7HEN. Solds,Duratl on
Kainfa!l
Usage
in Tier,2r2
-Collected
Unts)�
Annu
'
Monitoring? .
A
Simping v­
'(y /n)
is 100,
001
9/23/14
No Flow
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANYONE OUTFALL (INCLUDING ,VEHICLE mAINTENANCE)?YES [-]"NO Z
HAVE YOU CONTACTED THE REGICINT, YES- E!"NO M
REGIONAL OFFICE CONTACT NAME: Mooresville NCDENR.
Mail Original and one copy of this DMA (iriduclin� all "No Flow"-& "No Discharge reports) within 30 days of -receipt of sample (or at end of monitoring period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION: FOR.ANY INFORMATION REPORTED:
"I certify, under pe alty of law- that this clocument and all attachments were prepared undermy direction or'supervision in accordance with a system designed to
assure that qualifi person roperly gather and ovaluate the information, submitted. Based on,my inquiry of the person or persons who manage the system, or
those p rs ris it ctly r sible for gathering the information, the information submitted is, to the=best of my knowledge and belief, true, accurate, and complete. I
9
fi
a , r e
those
e'o under
penalties for submitting false information 1 possibility of fines -and imprisonmen . o
am th i including the possi.b t f r knowing violations."
($afZ �re of". rmltted) (Date)
Permit, Date: 7/1/2011-60/30/201.5 :Last Revised 7/13/11
Page 2 of 2