NCG020749 DMR SW (3)

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SEND TO CENTRAL OFFICE
STORMWA DISCHARGE OUTFALLS (SDO)
GENERAL PEitMIT NO. NCG020000
'Keport ALL STOKMWATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH / of each year.
CERTIFICATE OF COVERAGE NO. NCG02 0 / Lel
FACILITY NAME: D/I/ ✓E" /��
PERSON COLLECTING SAMPLES ' H7
CERTIFIED LABORATORY Lab #
Lab #
Part A: Stormwater Monitoring Requirements
SX IIPLIE COLLEC'T'ION YEAR: J0/$"
COUNTY-GUJt?i�li��rr
PHONE NO.
ADD TO LISTSERVE? YES [+ —N -O n EMAIL:
Ohultofall
_
Date Sample aln Tier 2
# of Months in
odd/ CollectedMonthly
Y I Monitoring'? Sampling, ie . Total Flow
NO FLOW (MG)
) (y/n)(mg/1)
" - -
Total Suspended
Solids
10
Turbidity Settleable
NTU
(NTU) Solids (mill)
See Footnote' 0.1
__........ ._
!!:vent
Duration
(minutes)
__...._._
'1'uial
Rainfall
(in)
6L41
f
i
-'raw
t^ ► l�= � `D LOW
0/h*_ 3 3D r
_.__..__.
2
~ t l5- 4 / p t�
CENTRAL I"ILES
DWR SE TION
- _ ..... ..
—
-----
If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" f
or
outfiall here and the
s e.
Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below lthe benchmark or within the b ate nchmark range
3 If a value is in excess of the benchmark, or outside the. benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit.
4 TSS benchmark values are 100,mg/l except in ORW, HWQ, trout, and PNA waters where they are 50 mg/1.
s The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water, to exceed: 10 NTU for freshwater streams, lakes, and reservoirs designated
as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/1/201,0-12/31/2014
Last Revised 02-02-11
POOP I W-)

Pn�F ii. Vot.dn,., fl�Yn:..4....n___ l _a__.ea_. •�
•••. _••�••••�.•..■..�
Outfall Date Sample
No. Collected
(mo/dd/yr OR
1
NO FLOW)
n�„�,. iV.unaorm Ke wrements for facilities
In Tier 2
Monthly # of Months New Motor
Monitoring?„ . in Tier2;, Oil Usage
(y/n) Ssmpling? ' aUmont6
using>
Total Flow
(NIG)
55 al of new motor oil/month
TPH using method
Itf64A:SGT-HEM
15
on aye e
` Total Suspended pH
. , Solids (Standard
m 1 Units
100 ' 6-9
Total
Rainfall
in
Event
Duration
minutes
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ONO
HAVE YOU CONTACTED THE REGION? YES O NO Q
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY aNCLUDING ALL "NO FLOW” "NO DISCRARGE" & LIMIT
VIOLATIONS BY MARCH I OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone] -
YOU MUST SIGN THIS CERTIFICATION FOR ANYINFORMATION REPORTED.
"1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision In accordance with a systell, desibgied
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. 1 am aware that there significant penalties for subg false information, including the possibility of fines and imprisonment for knowing
violations."
l F6K Ivtrxr, i% 3 t ty
(Signature of Per ittee) (Date)
Permit Date: 1/1/2010-12/31/2014
I,ast Rcvised 02-02-11