NCG140366 DMR SW

STORMWATER DISCHARGE OUTFALL (S®O) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 6
FACILITY NAME: PkT Co N Q erg
PERSON COLLECTING SAMPLES j<jpMRq
CERTIFIED LABORATORY M I C (R -O U aC', Lab # I
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION Y R: ' =� ®ls�__
SAMPLINGPERIOD: 1i July -December 01January-June
COUNTY
PHONE NOLc,j aq3, C)3.0
ADD TO LISTSERVE? ❑YES ONO EMAIL: s q V
V /
DISCHARGING TO CLASS: OSA ❑HQW ❑PNA ❑Trout Other l �v
Outfall No.
Date Sample
Collected pH
(Standard
(mo/dd/yr OR
NO FLOW)1 Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
Z
2 Sampling
-
- 6-92
1002'
-
-
-
-
O
. -_=
G
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, HOW, 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.
Soki DS
40.10
Mqk-
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
No.
Date Sample'
Collected
(mo/dd/yr)1
pH
(Standard
Units)
TPH using method Total,Suspended
1664A SGT --HEM Solids
(mg/L) (mg/L)
Event
Duration
(minutes)
Total
Rainfalla
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthl y
Monitoring?
(y/n)
# of Months
in Tier 2
z
Sampling
6-9z
15Z 100zs
-
-
-
-
-
1
S
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDE CES AT ANYONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO 19/
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 (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 properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible4or gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware that n penalti for submitting false information, including the possibUN ility of fines nd imprisonment for knowing violations."
// / r-1
(Signa re of Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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