NCG140382 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL 'PERMIT NO.
CERTIFICATE OF COVERAGE N.O. NCG14 O $ 2
FACILITY NAME: �DO—L I �fA W M i X om Asay l c -l.£ WAjor
PERSON COLLECTING SAMPLES�iF�c-�crl
CERTIFIED LABORATORY tAa An1ALYTICA Lr Lab #
Lab #
OPTIONAL INFO:
.
- Semi -Annual MONITORING FORM
NCG140000
SAMPLE COLLECTION YEAR: 2-00 S APR 2 9 20)�
SAMPLING P RIOD: E] July -December ,January -June CENTRAL FILES
COUNTY.OtS®,a SWR SECTION
PHONE NO. ($26) -37-- 4170 O
ADD TO LISTSERVE? RYES []NO EMAIL:
DISCHARGING TO CLASS: RSA RHQW RPNA RTrout MOther_19
rar[ t►: atormwater Monitoring Requirements
Date Sample i
Outfall No.
Collected pH TSS i Event Total In Tier 2
ar
(mo/dd/yr OR (mg/L) Duration Rainfall Months (Standard 4 Monthly # of in Tier
NO FLOW)' Units) � (minutes) (in) Monitoring? 2 SamplingZ
(y/n)
- 6-9 100
1 3 t ri 1s� 15 9. Z. 3 0 2�I 0 , b N -
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE"
Z for each outfall here. Please make sure to marls the sample period above.
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, Tout, 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/l/2011-60/30/2015
Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
In Tier 2
Monthly # of Months
PH TPI1 using method Total Suspended Event Total New: Motor Oil in Tier 2
Outfall Date Sample (Standard 1664A SGT -HEM Solids Duration Rainfall° Usage Monitoring? 2
No. Collected Units) (mg/L) (mg/L) (minutes) (in) (gal/month) Wn) Sampling
(mo/dd/yr)1
--nn2,3
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 co of this DMR includin all "No Flow" & "No Dischar e" re orts within 30 days of receipt of sample or at end of monitoring
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 dir tly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am ar t t re ficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Zd /S
(D te)
ISianature of ermitte
Last Revised 7/13/11
Permit Date: 7/1/2011-60/30/2015 Page 2 of 2