NCG140347 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NIS #GIff-A49
FACILITY NAME: _Thomas Concrete of Carolina-Fuquay Varina Plant_
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY ESC Lab # ENV 375_
Lab #
OPTIONAL INFO:
SAMPLE COLLECTION YEAR 75
SAMPLING PERIOD: ® July -December ❑ January -June
COUNTY Harnett
PHONE NO. [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: [:]SA ❑HQW ❑PNA ❑Trout ®Other,
Part A: Stormwater Monitoring Requirements
Date Sample H
Collected p
Outfall No. (Standard
(mo/dd/yr OR
NO FLOW)1 Units)
Event Total In Tier 2
4 Monthly
TSS Duration Rainfall
(mg/L) Monitoring?
(minutes) (in) (y/n)
# of Months in Tier
2 Sampling2
- - 6-92
1002'3-
001 No Discharge
n
P
1
AP
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/l, 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.
I N E
4 ?L':?
L FILES
'CTION
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 vear
Outfall
No.
Date Sample pH
(Standard
Collected Units)
(mo/dd/yr)1
6-92
TPH using method
1664A SGT -HEM
(m g/'
L)
152
Total Suspended Event
Solids Duration
(mg/L) (minutes)
1002'3 -
2 Tier
Total New Motor Oil In InTier# of Months
Rainfalla Usage Monthly in Tier 2
m
() (gal/month) Monitoring? Sampling2
(Y/n)
- - - -
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 (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 responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
41 am aware that there are significant penalties'fdr'submitting false information, including the possibility of fines and"mprisoenment for knowing violations."
(Signature of Permittee)
1/31/2016
(Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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