NCG140418 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NQG1
FACILITY NAME: Thomas Concrete of Carolina-Knightdale Plant_
PERSON COLLECTING SAMPLES Susan Bostian
CERTIFIED LABORATORY ESC Lab # ENV 375_
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION - - 201 11
SAMPLING PERIOD: ® July -December ❑ January -June
COUNTY Wake
PHONE NO. [phone]
ADD TO LISTSERVE? []YES ®NO EMAIL:
DISCHARGING TO CLASS: ®SA ❑HQW ❑PNA ❑Trout [:]Other
Date Sample
Collected
Outfall No.
(mo/dd/yr OR
NO FLOW)'
pH
TSS
(Standard
Units) (mg/L)
Event Total
a
Duration Rainfall
(minutes) (in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
- -
6-92 100",
- -
-
-
001 No Discharge
0
N
016
CENT
SWR S
E CTION
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 m 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.
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 Date Sample pH
(Standard
TPH using method
1664A
Total Suspended Event
Total New Motor Oil In Tier 2 # of Months
No. Collected
Units)
SGT -HEM
Solids Duration
Rainfal14 Usage Monthly in Tier 2
(mo/dd/yr)1
(mg/L)
(mg/L) (minutes)
Monitoring? g2
(in) (gal/month) Samplin
(y/n)
6-92
-1002,3
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ONO
HAVE YOU CONTACTED THE REGION? YES [:1 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
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date. 7/l/2011-60/30/2015
1/31/2016
(Date)
Last Revised 7/13/11
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