NCG140350 DMR SW (7)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14035.0
FACILITY NAME: _Thomas Concrete of Carolina -Wake Forest Plant_
PERSON COLLECTING SAMPLES Kevin Kelt
CERTIFIED LABORATORY ESC Lab # ENV 375_
Lab #
OPTIONAL INFO: December Monitoring Event
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2015
SAMPLING PERIOD: ® July -December ❑ January -June
COUNTY Wake
PHONE NO. [phone]
ADD TO LISTSERVE? DYES ®NO EMAIL:
DISCHARGING TO CLASS: DSA ❑HQW ❑PNA [—]Trout ®Other
Outfall No .,
Y
Date 5ampleau
Collected; E pH
(mo%dd/yr'OR {Standard
NO FLOW)1 Units)
a
z w Event
TSS
Duration
(mg/L)
a, (minutes)
Notal
a
Rainfall
In Tie�2 7
-
Monthly #hof Months m Tier,
2
Monitorings & 2 Sampling
/n)
.
Pa..
6 9
100'
r
001
No discharge
Y11
a,l
DWR
SECTION
n rvu rwvv ur NO ViKHARGE, Enter Nruu
u �vv or --Nui�UhAKLA" for eacn outtaii nere. 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/l.
° 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
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Dmr4 D• %1nhirin Unin4nnnnrn A,rtivity Mnnitnrino Rpnnirpmantc fnr fnrilitipc „cinp > 55 Pal of npw motor oil/month — averaeed over a calendar vear.
Outfall
No.
Date SampleSt
Collected 1 Sample(
(mo/dd/yr)
pH
andard
Units) .
TPH using method
1664A 56T -HEM
(mg/L)
Total Suspended Event
Solids Duration
(mg/L) (minutes)
Total New Motor Oil
a
Rainfall Usage
(in) (gal/ month)
In Tier 2 # of Months
Monthly
in Tier 2
Monitoring? Sampling2
(y/n)
6-9 15 100'-,-1- - -
- -
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:
"No Discharee" reoorts) within 30 days of rece
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 276,99-1617
"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 aware that there aresignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
1/31/2016
(Date)
Permit Date: 7/1/2011-60/310/2015 Last Revised 7/13/11
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