NCG020048 DMR SW (2)

ANNUAL SUMMARY DMR. - STORMWATER
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STORMWATER DISCHARGE OUTFALLS (SDO) 2016
GENERAL PERMIT NO. NCG020000
1 ALG STORM WATER M'anitoring+Data ron this' forSn (�inc'lading"No 'FPow and No �,!5j"scharge'and':P;er;mt�11471i�t_ Viol'atYans); byMARCH I' bf e'aclr;j�e'aii
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6/9
COVERAGE NO. NCG0219COUNTY
SAMPLE COLLECTION YEAR:
2O
CERTIFICATE OF
0-0 f'U 'rt; e--5
FACILITY NAME:
PHONE NO. W)
PERSON COLLECTING SAMPL S
ADD TO LISTSERVE? YES ❑ NO ❑ EMAIL:
CERTIFIED LABORATOR c' Lab #
Lab #
Part A: Stormwater Monitorin Re uirements
Date Sample In Tier 2 # of Months in
Outfall Collected Monthly Tier 2 Total Flow
Total Event
Total Suspended 'turbidit a Settleable
y Rainfall Duration
,�
No, (mo/dd/yr OR Monitoring. Sampling2 (MG)
Solids
(Mg/1)(NTU) Solids (ml/1) (in) (minutes)
NO FLOW) (y/n)
100, See Footnote '' 0.1
-
40, l
j - yA91
A /,-)
J
r 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 or Tier 2 responses in the General Permit.
4 TSS benchmark values are 100 mg/l except in ORW, HWQ, trout, and PNA waters where they are 50 mg/1.
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.
Last Revised 01-21-11
Permit Date: 1/1/2010-12/31/2014 Page 1 of 2

Part B: Vehicle Maintenance
Date Sample
Outfall Collected
No. (mo/dd/yr OR
NO FLOW)1
Activity Monitorin Requirements for facilities using > 55 gal of new motor oil/month on avera
In Tier 2 # of Months New Motor Total Flow TPH using metihoa iotai Ouspenueu
Monthly in ,Tier 2 Oil Usage (MG) 1664A SGT -HEM Solids
Monitoring? Sampling2 al/month (m ) (mg/1)
(y/n) 153 1003
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)?
HAVE YOU CONTACTED THE REGION?
WHO AT THE REGION HAVE YOU SPOKEN WITH?
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
[phone]
YES ❑ NO
YES ❑ NO ❑
pH I Total Event
(Standard Rainfall Duration
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 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
Permit nate: 1/1/2010-12/31/2014
(Date)
Last Revised 0 1 -21 -11
Page 2 of 2