NCG140001 DMR SW (11)

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: April 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? []YES ®NO EMAIL:
DISCHARGING TO CLASS: ❑SA ®HQW ❑PNA ❑Trout
❑Other
:. Date Sample'�
Collected
Outfall No.,,.,
(mo/dd/yr OR
a i
NO FLOW) , ,..
21
pH
TSS _
(Standard °-°
Units) (mg/L)
r
Event
Duration
(minutes)
��
In Tier 2�
Total
4 , Monthly of Months in Tier
Rainfall
Mo ng? 2 Sampling
(in) niton
(Y/n) n
6-92 1002,3
001 No Discharge
y 13
NO FLOW" or "NO DISCHARGE. Enter "NO FLOW" or "NO nISCHARGF" fnr Parh outfall harp PIPacP maks corp to mark the cmmnla norm 1 nhnvn
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.
a TSS benchmark values are 100 mg/I, 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 Date Sample
No. Collected (mo/dd/y)1
pH
(Standard
Units)
6-9'
TPH using method
1664A SGT -HEM
(mg/L)
15'
Total Suspended Event
Solids Duration
(mg/L) (minutes)
1002,1
Total New Motor Oil In Tier 2 # of Months
Rainfall' Usage Monthly in Tier 2
(in) (gal/month) Monitoring? Sampling'
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:
ail Original
case of "No
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 2
YOU MUST SIGN THIS C
"I certify, under penalty
assure that qualified pe
those persons directly n
am aware that there arA
(Signature of Permittee)
n 30 days of receipt of
1617
law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
nnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
onsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
;nificant penal *fojr submitting false information, including the possibility of fines and imprisonment for knowing violations."
6/8/2015
(Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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