NCG140114 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCC _
FACILITY NAME: Rra. MW� (_bKtrf,•- C&
PERSON COLLECTING SAMPLES l4)Wr-} A toywl7owyN ! r"
CERTIFIED LABORATORY E)7Vi ruvlvhteh+ I Lab # /
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: Z a/ 1,10 R F7C F7� p @� p❑ [l
SAMPLING PERIOD: ❑ July -December �Rjanuary-June l
COUNTY APR 2 0 2016
PHONE NO. (2 -SZ) �s3^�'�5 DWR SECTION
ADD TO LISTSERVE? [—]YES 4E§NO EMAIL: ne
DISCHARGING TO CLASS: DSA ❑HQW ❑PNA rou UNIT
Date Sample
Collected
Outfall No. (mo/dd/yr OR
NO FLOW)1
PH
(Standard
units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
Rainfall n
(in)
In Tier 2
Monthly # of Months in Tier
Monitoring? 2 SamplingZ
(y/n)
-
0b
2,5
A; A/14
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.
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
Collected
1
(mo/dd/yr)
pH
(Standard
Units)
• - 6-9
TPH using method
2664A SGT -HEM
(mg/L)
15
Total Suspended Event
Solids Duration
(mg/L) (minutes) -
100 '
Total New Motor Oil Monthly In Tier 2 # of Months
Rainfalla Usage y in Tier 2
(in) (gal/month) Monitoring? Sampling2
(y/n)
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC�FS 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: DWQCentral 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 person i ectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am a are t ere are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
0 V Idol
I ture ermittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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