NCG140362 DMR SW (2)

"ift
STOR MWATER OUTFALL (S®O) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 G 3 { /��
FACILITY NAME: PkT CG Is Qzer ., S§ �j.1(C.LCJ , Ik, C. .
PERSON COLLECTING SAMPLES- ICQMAq P&MLUI
CERTIFIED LABORATORY M (C.(ZO Q ft C-. Lab # -
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION Y R: C�® (
SAMPLING PERIOD: M July -December ❑,January -June
COUNTY iE(1L1S-10/J
PHONE NO. (Psa) q3, CISdG
ADD TO LISTSERVE? ❑YES [:]NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other MS W
Date Sample Collected
Outfall No.
(mo/dd/yr OR
NO FL0W)1
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfal14
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
- -
6-92
1002'3
-
-
-
-
i0.�
a o
a.sAJ
ej
V�
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.
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.
c04«03(zm
-1k c6k-,
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 r
( / /v )�
pH .,' TPH using,method
"
(Standard ..1664A SGT -HEM
Units) (mg%L),
Total Suspended`
Solids
(mg/L) .„(minutes),
Event Total, Nevi Motor OilIn
� � a
Duration Rainfall , Usage
•(in) (gal/month)„
Tier .
Monthly - , `
Monitoring?
(y/n)
�'# of Month`s
in Tier 2
2
Sampling
6-92` 15�
100'34v
I
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDE CES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO M/
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copv of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or 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 proper) gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible fo athering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there nalties r ubmitting false information, including the possibility f finza.
nd imprisonment for knowing violations."
(Signature f Permittee) ( te)
Permit Date.77 'r/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2