NCG020007 DMR SW

( *Report ALL .STORA?ttATER Monitoring Hata on, this form (including No Flow and No Discharge and Permit Limit Violations) by "CHI ofeach year.
CERTIFICATE OF COVERAGE No. NCG02
FACILITY NAME: .,, Co
PERSON COLLECTING SAMPLES. '
CERTIFIED LABORATORY Lab #
Lab #
Part A: Stormwater Monitorinn Reauirements
SAMPLE L�ECTIO�T YEAR:
COUNTY c
PHONE NO.
ADD TO LISTERVE? YESNO EMAIL:
TOTAL RAINFALL: LI,Z, -7(e INCHES
EVENT DURATION: MINUTES
Date Sample
Collected
Outfall No.
(mo/dd/yr OR
NO T'Low),
In Tier 2
monthly
Monitoring?
(y/n)
of Months in
Total Suspended
Tier 2 x Total Flow Solids
Sampling '(MG) • , (MA(1'dTtl7
.
Turbidity4Settleabie Solids
(ml/l)
Q
100'
��
SeeFootzeote-- 0.1
1
v
2 201
v
TICR.TrI L? 1-M771 ..- {tl.Tl1 TTRl�TT r
11 ..W rL� TY UL
iNv ,�iovntucvrs, nnier --ivv -r-LV w � � or --.NU 1J1bCHAxGE " for each outfall here and the Date Range.
z Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 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.
4 TSS benchmark values are 100 mg/l except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
5 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 lake's 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: 1/1/2010-12/31/201 s
S
Last Revised 01-19-10
Pagel of 2

Part B: Vehicle Maintenance Activity Monitorin Re uirements for facilities USinq > 55 a1 of new motor il/ th o
Outfall Date Sample
Collected
No..'mo/dd/ r OR
( Y
NO FLOW)'nils
In Tier 2
M°rattily. n# of Months
in Tier 2
Ma Monitoring.
Sampling
New. Motor Oil
Usage
(gallmonth).
o mon on aver"KV
Total Flow TPH using Total Suspended
(MG) ,nethod I664A Solids,
SGT -HEM (moll)
pH,
(Standard
Units)
- - 153*100
6-4
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEENDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO I.
HAVE YOU CONTACTED THE REGION? YES []NO ❑
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL -AND ONE COPY OF TATS ANNUAL SUA'IMARY (INCLUDING ALL "NO FLOW" "NO DISCHARGE" t& 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
YOUMUST SIGN THIS CERTIFICATION FOR ANYINFORMATION REPORTED:
"I c rtify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to a sure that qualified perso el properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the
sy t m, or those pe dire y responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate,
a complete. awa a th _there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
atio�ts."
a
'
lifiature o tt I /9J&
ate
Permit Date: 1/1/2010-12/31/ 0 Last Revised 01-19-10
Page 2 of 2