NCG140423 DMR SW (4)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 0 3
FACILITY NAME::aX 5tj+k Ze d i m i x
PERSON COLLECTING SAMPLES F—r; c. ►7r_ia n
CERTIFIED LABORATORY Qe,jctfc, r% -F foal Say Lab # 3q_
Lab#
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: Z� � RECEIVED
pp
SAMPLING PERIOD: ❑ July -December 1anuary-.1 0 9 2015
COUNTY brc,,n4-k DEN:'RAL FILE's
PHONE NO. (33(y 9V - (7�1�-Ili DWR �t� TION
ADD TO LISTSERVE? nYES 2NO EMAIL:
DISCHARGING TO CLASS: OSA ❑HQW OPNA ❑Trout [✓Other
Ir imu rLuvv" or -liu urJLtiAm3t, tnter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
a 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/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
Date Sample
Collected
RH
TSS
Event
;Total
s fn Tier:2
Outfall No
(mo/dd/yr OR
(Standard
m
( g/L)
Duration
a
Rainfall ..:
Monthly # of Months in{Tier
Monitoring?.21S mplin9
NO.FLOW)1
Units)
(minutes)
;: (iIn
lvLn)
t-9
100
Ir imu rLuvv" or -liu urJLtiAm3t, tnter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
a 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/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 8: Vehicle Maintenance Activity Monitoring Requirements for facilities
Ing > 55 gal of new motor oil/month — averaged over a calendar y
nded Event
Total
New Motor Oil
�n.T
Duration
Rainfall°
Usage
MO1
(minutes)(gal
/month);
on
(Y
AQ(I IZa
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES R NOE'
REGIONAL OFFICE CONTACT NAME: 7:YaSor, 'Sof c r
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. I
am at there a ignif1 ant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
l \
Si re of Permittee (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2