NCG140130 DMR SW

MAR 14 2016
CENTRAL FILES
DWR SECTION
STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 V -13--Q
FACILITY NAME: KnUQ
PERSON COLLECTING SAMPFLE L `N
CERTIFIED LABORATORY Lab #
Lab #
OPTIONAL INFO:
SAMPLE COLLECTION YEAR: Z O f6
SAMPLING PERIOD: ❑ July -December Cf January -June
COUNTY Pt d'S
PHONENO.( ,kG) 364
ADD TO LISTSERVE? ❑YES [I]NO EMAIL:
DISCHARGING TO CLASS: DSA ❑HQW ❑PNA ❑Trout ❑Other,
rart A: atorm-d— IYIVnRunn6 nayau co,v.w
Date Sample
Collected
Outfall No. (mo/dd/yr OR
NO FLOW)'
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
In Tier 2
Monthly # of Months in Tier
z
Monitoring? 2 Sampling
(Y/n)
i z q 1So
1.0
10r 3
Iz0
• 5�
--
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
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/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: 7/1/2011-60/3D/2015
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Part B: Vehicle Maintenance Activitv Monitorine Requirements for facilities using> 55 gal of new motor oil/month — averaged over a calendar year.
Outfall Date Sample
No. Collected
(mo/dd/yr)'
pH
(Standard
Units)
6 y
7PH using method
1664ASGT•HEM
(mg/Q
15
Total Suspended Event
Solids Duration
(mg/L) (minutes)
100
Total New Motor Oil In Tier 2 # of Months
, Monthly
Rainfall Usage in Tier 2
Monitoring? 2
(in) (gal/month) (y/n) Sampling
I
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NOV
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 for 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.
am aware th here are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signal of P mittee) (Date)
Permit Date: 7/l/2011-60/30/2015 Last Revised 7/13/11
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