NCG020135 DMR SW (2)

II ANNUAL SUMMARY DMR - STORMWATER II
,SEND TO CENTRAL OFFICE*
STORIVIWATER DISCHARGE OUTFALLS (SDO)
GENERAL PERMIT NO. NCG020000
*Report ALL'STORt1'l1fATER Monitoring Data on this form (including No Flow and No Discharge and Pernul Linut Violations) by MARCH 1 of each year
CERTIFICATE OF COVERAGE NO. NCG020135 SAMPLE COLLECTION YEAR: 2015
FACILITY NAME: Bessemer City Quarry COUNTY: Gaston
PERSON COLLECTING SAMPLES: Ronald Borum PHONE NO. [phone]
CERTIFIED LABORATORY: PACE ANALYTICAL Lab #12 ADD TO LISTERVE? YES ❑ NO ❑ EMAIL:
Part A. Stornwater Monitoring Requirements
Outfall
No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
In Tier 2
Monthly # of Months in Total Flow
Monitoring? Tier 2 (MG)
(y/n) Sampling2
Total Suspended Total Event
Solids Turbidity4 Settleable Rainfall Duration
(mg/1) (NTU) Solids (ml/1) (in)
-
-
- - -
1003'4 See Footnote 3,4 0.1 3
Outfall 003
No Discharge
1/1/15-6/30/15
Outfall 003
1 No Discharge
7/1/15-12/31/15
ilf "NO FLOW" or "NO DISCHARGE," enter "NO FLOW" of "NO DISCHARGE" for each outfall here and the Date Range
2Pei NCG02 Tiei 2 Monthly Sampling sliall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 I a value is to excess of the benchmark, of outside the benchmark range (for pH), you must implement the Ten• I or Tier 2 responses in the General Permit
4TSS benclumaik values are 100 mg/I except in ORW, HWQ, bout, and PNA waters where they are 50 mg/I
5The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed 10 NTU for freshwater sheams, lakes, and leservois designated
as trout waters, 25 NTU for all lakes and reservois, and all salt water, 50 NTU for all other streams and surface waters Tuibidity may be monitored at the SDO
Alternatively, the pernmttee may choose to monitor turbidity in the i ecervmg 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

Part A. Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average
Date Sample
Outfall Collected
No. (mo/dd/yr OR
NO FLOW)'
In Tier 2
Monthly # of Months in New Motor
Monitoring? Tier 2 Oil Usage
(y/n) SamplingZ (gal/month)
-
Total Flow TPH using method
(MG) 1664A SCT -HEM
(mg/1)
- 15 3
Total Suspended
Solids
(mg/I)
100 3
pH Total Event
(Standard Rainfall Duration
Units) (in)
6-9 3
Outfall 002 No Discharge
Outfall 002 No Discharge
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION?
WHO AT THE REGION HAVE YOU SPOKEN WITH?
YES ❑ NO ❑
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY QNCLUDING 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]
YOUMUST SIGN THIS CERTIFICATION FOR ANY INFORMA TION REPOR TED:
"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." -7
ef— -� O 2/15/16
(Signature ti Permittee) (Date)
Permit Date 1/1/2010-12/31/2014 Last Revised 01-21-11
Page 2 of 2

Part A• 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/11)
# of Months in New Motor
Tier 2 Oil Usage
SamplingZ (gal/month)
Total Flow TPH using niethod
(MG) 1664A SGT -HEM
(mg/1)
Total Suspended
Solids
(mg/1)
pH Total Event
(Standard Rainfall Duration
Units) (in)
- - 15 3 100 3
6-9 3
N/A Comin led Water
N/A Commgled Water
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION?
WHO AT THE REGION HAVE YOU SPOKEN WITH?
YES ❑ NO ❑
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]
YOUMUS T SIGN THIS CER TIFICA TION FOR ANY INFORMA TION REPOR TED:
"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."
7
2/15/16
(Signature of Permittee) (Date)
Pennit Date 1/1/2010-12/31/2014 Last Revised 01-21-11