NCG140423 DMR SW (5)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO.
FACILITY NAME:+__Zt'/-1Y!X
PERSON COLLECTING SAMPLES hie 5 i2,6--0
CERTIFIED LABORATORY Pe5&FiWW4 I Lab # S�
%boy.1i 9. T n Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: ?01 3 Needy ""
SAMPLING PERIOD: [ uuly-December ❑ January -June OCT 0 7 1015
COUNTY T:F_sr-SL4•�-I CEjq-rrz4L AIL
PHONE NO. ("�3tv )_ qLp i -0(G(4 I,O DWIR SS�CrION
ADD TO LISTSERVE? ❑YES '©NO EMAIL;
DISCHARGING TO CLASS: EISA ❑HQW ❑PNA ❑Trout ether
Date Sample
Collected
Outfall No.
(mo/dd/yr OR
1
NO FLOW)
pH
(Standard,
Units)
TSS
m g/L)
Event
Duration
(minutes)
Total a
Rainfall
(in)
In Tier 2
Monthly # of Months in Tier
? z
Monitoring. 2 Sampling
(y/n)
-
6-9Z
100 ,3
L �- L ►
u `-2-o
n nu rww or ivv uwt.11AKM, tnter NO FLOW" or "NU DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
a 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/I.
"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
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)
6-9
TPH, using method
1664A SGT -HEM,
(mg/L)
15
Total Suspended
Solids
(mg/L)
1002'3
Event Total
Duration Rainfalla
(minutes) , • (in)
- -
In Tier 2
New Motor Oil ,Monthly' # of Months,
Usage Monitoring? in Tier 22
(gal/month) (v/n) Sampling
- - -
-ZZ-i
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO [V
HAVE YOU CONTACTED THE REGION? XFS ❑ NO
REGIONAL OFFICE CONTACT NAME: QCL--�Cll--, f
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitorine period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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.
am aware that there are significant penalties for submitting false information, including the possibilityoff fines and imprisonment for knowing violations."
1504fure of Pffl.r fie) (136te) f
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

Eimwohimmiml Flo hw
mUd
1-.lJ. UV/\ / VV:JI I,IY Vl1l\IVIVIV I LJI.11 V L _
GREENVILLE,=N:C:_27835-7085_
READY MIX CONCRETE (AYDEN)
MR. RICKIE GRAY
P.O. BOX 877
GREENVILLE ,NC 27834
ID#: 1097
DATE COLLECTED: 09/24/15
DATE REPORTED : 09/29/15
REVIEWED BY:
001 002 Analysis Method
PARAMETERS Discharge Discharge Date Analyst Code
PH (not to be used for reporting) 7.2 8.0 09/25/15 KKF 4500HB-00
Total Suspended Residue, mg/l <2.6 3.3 09/28/15 MLH 2540D-97
13
/JV-VLVV _
756--0633-,---
REVIEWED
56-0633_.