NCG140107 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
SAMPLE COLLECTION YEAR: Zq!5
CERTIFICATE OF COVERAGE NO �NCG14��74 p ERI D: �1u) -December ❑ January -June
Mr7=FACILITY NAME: N
PERSON COLLECTING SAMPLES N (441-L .
CERTIFIED LABORATORY Lab # DEC ADD TO L STSERVE? ❑YES [:]NO EMAIL:
Lab # GENTWMRAfMG TO CLASS: [—]SA ❑HQW ❑PNA ❑Trout ❑Other,
OPTIONAL INFO: SECTION
Part A: Stormwater Monitoring Requirements
Date Sample In Tier 2
Collected PH TSS Duration Event RaTotalinfall 4 Monthly # of Months in Tier
Outfall No. (Standard Monitoring? 2 SamplingZ
(ma/dd/yr OR Units) (mg/L) (minutes) (in)
NO FLOW) (Y/n)
6-92 1002'3 - -
r
L 3a
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.
2 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, 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/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge.
Last Revised 7/13/11
Permit Date: 7/1/2011-60/30/2015 I
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oma.. u. vetiiA. Mointnnsncn Activity Mnnitnrinw Renuiramnnts for fariiities using > SS gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
pH
Date Sample(
Standard
Collected Units)
(mo/dd/yr)'
6-9 2
TPH using method
1664A SGT --HEM
(mg/L)
15
Total Suspended Event
Solids Duration
(mg/L) (minutes)
100 , -
Total New Motor Oil In Tier 2 # of Months
a Monthly
Rainfall Usage in Tier 2
(in) (gal/month) Monitoring? Sampling2
(y/n)
- - - -
I
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 coot/ 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 MUSTS/GN 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 t t q; lified parsoAnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those er o s irectl es risible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aart they r nificant penalties for submitting false information, including the possibility ol fines a d im
V'zs prisonment for knowing violations.
(Signat rue of Permilitee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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