NCG020155 DMR SW (2)

ANNUAL SUMMARY DMR - STORMWATER
II SEND TO CENTRAL OFFICE * II
STORVIWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
*Report ALL STORMWATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year.
CERTIFICATE OF COVERAGE NO. QN. GG02.0155
FACILITY NAME: _Shelton Quarry
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY Research & Analytical Labs Lab # _NC #34.
Lab #
Part A: Stormwater Monitorinu Requirements
SAMPLE COLLECTION YEAR: _
COUNTY Caswell
In Tier 2
Monthly
Monitoring?
(y/n)
PHONE NO. [phone]
Total Flow
(MG)
ADD TO LISTERVE? YES
❑ NO
TOTAL RAINFALL:
51.8
EVENT DURATION: - _
40,620
2015
EMAIL:
INCHES
MINUTES
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in
Tier 2
Samplingz
Total Flow
(MG)
Total Suspended 4
Turbidity
Solids
(mg/1) (NTU)
Settleable Solids
(ml/1)
-
-
-
-
-
1003,4 See Footnote 3, 5
0.13
002
NOFLOW 01/14-
12/14
-
-
-
- -
-
-
-
-
-
-
- tt a %—# L--8 V -SLA
-
, HLES
If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range
2 Per NCG02. Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 of Tier 21esponses in the General Permit.
4 TSS benchmark values are 100 mg/l except in ORW, HWQ, trout, and PNA waters where they ale 50 mg/l.
5 The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, 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 may be monitored at the SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO
Permit Date: 1/1/2010-12/31/2014 Last Revised 01-19-10
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Part B: Vehicle Maintenance Activity MonitoringRe uirements for facilities using > 55 gal of new motor oil/month on avera e
Date Sample In Tier 2
Outfall Collected Monthly
No. y
(mo/dd/yr OR Monitoring?'
NO FLOW) (y/n)
# of Months
in Tier 2
Sampling
New Motor Oil Total Flow TPH using
Usa MG method I664A
Usage ()
(gal/mouth) SCT -HEM
(m /1)
Total Suspended pH,
Solids Standard
' (
(mg/1) Units)
1003 6-93
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEENDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH I OF EACH YEAR 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:
"1 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
violations."
Permit Date 1 / 1 /2010-12/31 /2014
(date)
Last Revised 01-19-10
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