NCG140035 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NC 14_I (�L�
FACILITY NAME: &IzIll L M (Y1G 415x,
PERSON COLLECTINGS M/�P�iLES i
CERTIFIED LABORATORY CC2In�2D�
SAMPLE COLLECTION YEAR:
RECEIVED
OCT 2 6 1015
SAMPLING PERIOD: [ ] July -December O January -June CENT
COUNTY ,- YL TION
PHONE NO. {)
- DWR SECTION
ADD TO LISTSERVE? DYES [_]NO EMAIL:
DISCHARGING TO CLASS: OSA OHQW OPNA ❑Trout ❑Other
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
Date Sample {n Tier 2
PH T55 Event Total 4 Monthly # of Months in Tier
Collected Duration Rainfall
Outfall No. (Standard L Monitoring? 2 Samplings
m
(mo/dd/yr OR Units) ( g/) (minutes) (in) (y/n)
NO FLOW)'
1 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.
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.
a TSS benchmark values are 100 mg/1, except when discharging to ORW, HOW, 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

ft
Part R- Vahirla MaintPnanep Activitv Monitorine Reouirements for facilities using > 55 eat of new motor oil/month — averaged over a calendar year.
Outfall
No.
PH TPH using method Total Suspended Event Total New Motor Oil In Tier 2 # of Months
Date Sample a Monthly
(Standard 1664A SGT -HEM Solids Duration Rainfall Usage � in Tier 2
collected I Units) (mg/L) (mg/L) (minutes) (in) (gal/month) Monitoring. Sampling2
(mo/dd/yr} (y/n)
I
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:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for at end of monitoring 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 away tha there ar ignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
Page 2 of 2

Cameron Testing Services, Inc. Laboratory Report
Client: Ready Mixed Concrete CTS Proj.
Project; 2015 Semi -Annual SVS #2 Regulatory
Sample Information
Sampled M Setzer 'Date 10/02/15 Received
Analyses and Results
NC DENR #654
NC PHHS #37799
US EPA #NC01918
151366
Yes
C Cameron Date 10/02/15
Report
Review
Lab Director
219 S Steele Str
Sanford NC 27330
lO
Date
w Std Methods
Reference
2540 D - TSS
4500 H B - pH
2540 D - TSS
4500 H B - pH
919-201-4240
clms,2i camerontewng Com
Lab ID Sample ID
X
CLY
c
Analyte
Result
J
(n
o
a
U
_
4
151366 01 Road #2
sw
Gr
TSS
363
mg/L
4 17
10/07/15
pH
648
s u
0
10/02/15
02 Plant #1
sw
Gr
TSS
390
mg/L
625
10/07/15
pH
634
S u
0
10/02/15
Report
Review
Lab Director
219 S Steele Str
Sanford NC 27330
lO
Date
w Std Methods
Reference
2540 D - TSS
4500 H B - pH
2540 D - TSS
4500 H B - pH
919-201-4240
clms,2i camerontewng Com