NCG020221 DMR SW (2)

N
ANNUAL SUMMARY DMR - STORMWATER
FEB 2 3 z
ILA.`SEND TO CENTRAL OFFICE * �
CENTRAL FILES
DWR SECTION
STORMWATRR DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
*Report ALL STORMWA TER Monitoring Data ori this form (including -No Flow and No Discharge and Permit Limit Violations) by M4RCH'1 of each year. '
CERTIFICATE OF COVERAGE NO. NC%ft2-KgjgNMM0 SAMPLE COLLECTION YEAR: ►--
FACILITY NAME: _Rr; bdt)Ck .�11.�1� COUNTY ANS o,*,''
PERSON COLLECTING SAMPLES 7-j At �'®ivies 5 PHONE NO. ( z1) I. VA - 3 S 914
CERTIFIED LABORATORY Y' Cj: Lab # Y a ADD TO LISTSERVE? YES []NO[] EMAIL:
Lab #
Part A: Stormwater Monitoring Requirements
Outfall
No.
Date Sample
Collected,
(mo/dd/yr OR
NO FLOW)
In Tier 2
Monthly
Monitoring.
(y/n)
# of Months in
Tier 2 Total Flow
Sampling2 (MG)
Total Suspended
Solids
(mg/1)
Turbidity
(NTU)
Settleable
Solids (ml/1)
Total Event -
Rainfall Duration
(in) (minutes)
-
-
-
- -
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'If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range.
z 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.
a TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l.
'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.
Permit Date: 1/1/2010-12/31/2014 Last Revised 02-02-11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average
Outfall
No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months 'New Motor
in Tier 2 Oil UsageG
a
Sampling al/month
-
Total Flow
� )
TPH using method
I664A SGT -HEM
m
Total Suspended
Solids
(mg/0
pH
(Standard
Units)
Total Event
Rainfall Duration
in minutes
-
153
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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
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THI_S ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT
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]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMA TION 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
violations."
(Signat of Permittee)
Permit ate:l/1/2010-12/31/2014
z j�
(Date)
Last Revised 02-02-11
Page 2 of 2