NCG140116 DMR SW (2)

STORMIA/A-TER DISCHARGE,OUT-,FALL,(SDO) =SemliAnnual
GENERAL PERMIT NOACG,140000__.
CERTIFICATE OF COVERAGE
FACILITY NAME: 12e�%iCrl (�ctcT� C'2�
PERSON COLLECTING SAMPLES ,nr"t.Ny t-<Afh6wf_
CERTIFIED LABORATORYt ,%-�&A±!jih rc4 Lab # �� y
Lab # `
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
MONITORINGTORK_1
SAMPLE COLLECTION YEAR: 1P10I G
SAMPLING, PERIOD: ❑July -December - gianuary-June
COUNTY f—gg_sY 44
PHONE NO. (a31b)
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA- ❑Trout
❑Other,
Outfall No.
Date Sample_
Collected
- - -
(mo%dd/yr OR
NO FLOW)'
PH
- (Standard
Units)_"
TSS
-
(mg/L)
"Event
Duration --•
(minutes)
' Total - '
4
- -
-Rainfall -
(in)
In Tier 2
Monthly
Monitoring?
(y/n) _
# of Months in Tier
2 Sampline
_
6-9z
100Z'3'
-
-
-
-
1
S -as io
&R
917.5
Lo
`
EC
2
t
CENTRALFILES
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.
Z If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 orTier 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, 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 vear
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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 orsupervision 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 responsiblefor ga ering the information, the information submitted is, to the best of my knowledge and belief; true, accurate, and complete.
am aware that there are significant ' ties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signa a of Permittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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