NCG140099 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 0 0 9 9
FACILITY NAME: Chandler Concrete Company - Sparta 505
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY:Blue Ridge Labs Inc. Lab #275
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitorine Requirements
SAMPLE COLLECTION YEAR:2016
SAMPLING PERIOD: ® July -December ❑ January -June
COUNTY Alleghany
PHONE NO. ( 336) 372 - 4348
ADD TO LISTSERVE? ❑YES ®NO EMAIL: _
DISCHARGING TO CLASS: ❑❑❑
SA
HQW PNA ❑Trout ®Other: C
Outfall No.
"
Date Sample P
Collected
(moJdd/yr OR
NO FLOW)1
pH
(Standard
Units)
TSS
(mg/L)
Event Total In Tier 2
4 Monthly
Duration Rainfal6
Monitoring.
(minutes) (in) (y/n)
# of Months in Tier
2
2 Sampling
-
-
6-94
100 2,3
1
NO FLOW
-
-
- - Y
12
C ".
FEB 0
CENTRA,
If "NO FLOW" or "NO
DISCHARGE. Enter "NO
FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
IV®
12016
. FILES
TION
2 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.
s TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l. Original -State
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge. ❑ Copy - State
❑ Copy - Plant
❑ Copy - File
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

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
(mo/dd/yr)1
pH
(Standard
Units)
TPH using method
1664A SGT -HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
2
Sampling
6-92
152
1002'3
NOT
APPLICABLE
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
iviau uriginai ana one cop'
.in case of "No Flow") to:..
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 276'.
"I certify, under penalty of I;
assure that qualified person
those persons directly spc
am aware thafilhl'� re stet
(Signature of Permittee)
Permit Date: 7/1/2011
of
-1617
FIN "'. Ii 0reffiT�ifif k
that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
del properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
si�bbI for gathering the information, the information submitted is, to the best of my kn wledge and belief, true, accurate, and complete
bfi'can p alties for submitting false information, including the possibility of fin s an imprisonment for knowing violations."
1
Last Revised 7/13/11
Page 2 of 2