NCG020749 DMR SW (9)

C n ANNUAL SUMMARY. — STORMWATER.,j
TO C
OAR SEND ENTRAL OFFICE'*
, STO WATER D18Ci�[ARGE OUTFALLS (SDO)
[ENR -LAND QUALITY GENERAL PEIMIT NO. NCG02Q,06D0
SIORi��1VvFTtRFrRi�'�';T;;l' - --
*Report,ALL STORMWATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH 1 cif each year.
CERTIFICATE OF COVERAGE No. NCGO2 .0a,q SAMPLE COLLECTION YEAR: . 201 �
FACIILITYNAME: TDAI !t4E'K 7r V7z P17- COUNTY .���1��
PERSON COLLECTING SAMPi.1Gg 4 = ' f�7 V1r p1•ii1 PHONE NO..'�
CERTIFIED LABORATORY /, �`' -, ab #, ADD TO LIS'
[✓VIVO ENIA11�; b�rt�'� �s��rrZ� �, Jc�l �2t�Iet�-
JLab #
'arC %; ARUrIHl YY it LCI- ITIUMMI 11A1'c
Date Sample in Tier 2
Outfall Collected Monthly
No. (mo/dd/yr OR Monitoring?
NO FLOW)' (y/n)
#.of Months in
Tier 2 Total Flow
g gam lin s (MG)
P
Total Suspended
Solids (NTU)
(mg/1)
Settleable
Solids (ml/1)
Total
Rainfall
(iu)
7L`veut
Dtlu anon
(sr,i,Iulss)
100' See Footnote's
0.1
j
/VP
r 3�l rAIT
— -
--
' if "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfali here ana the nate Kange.
2 Per NCG02: Tier 2 -Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
If a value is in excess of the.benebmark, or outside the benchmark range (for pH), you must Implement the Tier I or Tier 2 responses in the General Permit.
4 TSS benchmarievalues are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
s The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, Jakes,,and reservoirs designated
as trout waters;,25'NTU for all lakes and reservoirs, and all salt waters; 50'NTU for all other streams and surface waters, Turbidity ntay'be monitored at the SDO
Alternatively, the permittee may :choose to inonitor,turbidity in the receiving water, directly upstream and downstream of the SDO,
Permit Date: 1/1/2010-12/31/2014 Last Revised 0202-11
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V enoCae inaanienance Actevtt t -NO me uirernents for racatities
usin-g % SS. al of new motor oil/month
on average
Outfall Hate Sample
Col(o?cted
No.
mo/dd/ r ORM
NO FI.O�]N)1
In Tier 2
Monthly
?
o (y/n)ng'
# of Months
in Tier 2'
S? in
New Motor
Oil Usage
aUxniontl►
Total Flow TPH using me
(MG) I664A SGT HEM
m /l
Total.aus ended
p
Solids
(in /}
H
PH
(Standard
Units
Total
Rainfall
(in
Event
Duration
(Minot"
-
_ 153
"100
6-93-
_-__
—' --I
HAS YOUR FACILITY HAD 4 OR -MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL'(INCLUIDING VEHICLE MAINTENANCE)? YES ❑ NO g
HAVE YOU CONTACTED THE REGION? YES ,M NO Er
WHO AT THE REGION HAVE -.YOU SPOKEN WITH?
MAIL ORIGINAIL AND ONE COPY OF THIS ANNUALSUMMARY NCLUDING ALL "NO FLOW", 44 ` NO DISCHARGE" A, LI1bi r'
VIOLATIONQ BY MARCH I OF EACH YEAR TO: _ _.
Division of Water Quality'
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MIST .SIGN THIS CERTIFICATION FOR ANYIIVFORMA TION Rj!�PQRTED •
"I certify, under penalty of law, that this docuneent 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. Eased on my inquiry of the person or persons who e4nanage floe
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. I am aware O �� sig�� tles_for submitting false information, including the possibility of fines and imprisonneettt foo- I{nowj,,jg
violations."
-FhY %if eYa(Al t
(Signature of -1' mittee) (Date)Permit Date: 1/t/2010-12/31/2014
Last Revised 02-02-1 i
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