NCG140001 DMR SW (9)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140001
FACILITY NAME: Thomas Concrete of Carolina -Raleigh Plant_
PERSON COLLECTING SAMPLES NA
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 ❑ Janua-ry-June
COUNTY Wake
PHONE NO. [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: []SA ®HQW ❑PNA ❑Trout ❑Other,
R
Outfall No . ;
Date Sample
gi�,.Collected-
mo dd r11
NQ FLOW)1
`°.
PH -'
(Standard
Units)
�s
In Tier 2 E
Event � TotalC� ,
a- Monthly # of Months in Tier,.
Duration Rainfall .
(mg/L) a minutes i-WomtoringT2 Sam hn
( ) (n) Pg
001
12/17/15
9.65
65.0 1.25 y 21
FU C00-
s
MAR.
DWR SECTIO
it NU rwW or ivU uibLHAKbt, tnter --NU fLUW' or "NU 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/l, except when discharging to ORW, HQW, Trout, and'PNA waters where they are 50 mg/I. -
4 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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Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected 1
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
1664A SGT -HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event Total
Duration Rainfalla
(minutes) (in)
In Tier 2
New Motor Oil # of Months
Monthly Usage in Tier 2
2
(gal/month) Monitoring? Sampling
(y/n)
6-9 15
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 CONTACTi NAME:
Mail Orieinal an
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27
"I certify, under penalty of I
assure that qualified person
those persons directly.respc
am aware that there are sigi
1'�a4x,
(Signature of Permittee)
Permit Date: 7/1/2011
17
Y, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
el properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
sible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
fent penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
1/31/2016
(Date)
Last Revised 7/13/11
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