NCG140105 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 D 1 17 S
FACILITY NAME:
PERSON COLLECTING SAMPLES yj2is �J:�r✓
CERTIFIED LABORATORY 6[lr��^ _ Lab # /o93
Lab #
OPTIONAL INFO:
RECEIVED
SAMPLE COLLECTION YEAR: Z01 `J
SAMPLING PERIOD:July-December ❑ January -June AUG O 3 2015
COUNTY ee4f11, CENTRAL FILES
PHONE NO. 31- DWR SECTION
ADD TO LISTSERVE? []YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
Part A: Stormwater Monitoring KequiremeMb
Date Sample.In
(Standard PH TSS
Outfall No. (mo/dd/yr OR ( Units)dard (mg/L)
NO FLOW)
Event
Duration
Total
4
Rainfall(minutes) (in)
Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
_ - 6-92 1002'3
-
_
_
-
. Z3 -1 ( { 3
300
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Nease maKe sure Lo rndiR uie PCI .,u awvvc-
2 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.
Last Revised 7/13/11
Permit Date: 7/1/2011-60/30/2015
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onrt a- Vahirin Mninto„anrp Artivitv Mnnitnrine Requirements for facilities usine > SS eal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)'
pH TPH using method Total Suspended Event Total New Motor Oil
o
(Standard 1664A SGT -HEM Solids Duration Rainfall Usage
Units) (mg/L) (mg/L) (minutes) (in) (gal/month)
In Tier 2 # of Months
Monthly
in Tier 2
Monitoring? z
(y/n) Sampling
6-9 15 100 ' - -
- -
I
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 copv of this DMR (incl_udine 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 ylified personnel operly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persire re i e for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am awar t r a g ' cant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signat a of Permit e) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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