NCG020200 DMR SW (3)

II ANNUAL SUMMARY DMR - STORMWATER II
SEND TO CENTRAL OFFICE*
STORMWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
*Report ALL STORMWATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year
CERTIFICATE OF COVERAGE NO. NCG020200 SAMPLE COLLECTION YEAR: 2015
FACILITY NAME: Pollocksville Quarry COUNTY: Jones
PERSON COLLECTING SAMPLES: N/A PHONE NO. 919-781-4550
CERTIFIED LABORATORY: PACE ANALYTICAL Lab #67 ADD TO LISTERVE? YES ❑ NO ❑ EMAIL:
Part A- Stnrmwnter Mnnitnrino Rernprementc
Outfall
No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)t
In Tier 2
Monthly
Monitoring?
/n
# of Months in Total Flow
Tier 2 (MG)
SamplingZ
Total Suspended Total Event
Solids Turbidity° Settleable Rainfall Duration
(mg/1) (NTU) Solids (ml/I) (in)
-
-
-
- -
1003'4 See Footnote 3,4 0.1 3
No discharge for 2015
N
N/A
Site is not tooperation
Legend ND = Not detectable, N/A = Not appltcable
`If "NO FLOW" or "NO DISCHARGE," enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range
2Per NCG02 Tier 2 Monthly Sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 I a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Teir 1 or Tier 2 responses in the General Permit
4TSS benchmark values are 100 mg/1 except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l
5The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed 10 NTU for freshwater streams, lakes, and reservois designated
as trout waters, 25 NTU for all lakes and reservois, and all salt water, 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 01-21-11
Page 1 of 2

s y
Part A: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average
.10
Outfall
No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in New Motor
Tier 2 Oil Usage
Samplin92 (gal/month)
-
Total Flow TPH using method Total Suspended
(MG) 1664A SGT -HEM Solids
(mg/1) (mg/1)
- 15' 100 3
pH Total Event
(Standard Rainfall Duration
Units) (in)
6-9'
No discharge for 2015
N
N/A
Site is not in operation
Legend ND = Not detectable, N/A = Not applicable
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES NO m
HAVE YOU CONTACTED THE REGION? YES p NO m
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS 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 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 sumbitted. 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 imprisionment for knowing
violations."
(Signature of Permittee)
Permit Date 1/1/2010-12/31/2014
(Date)
2/3/16
Last Revised 01-21-11
Page 2 of 2