NCG140259 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. Iti�G-102'0�"r" SAMPLE COLLECTION YEAR: p..1 I l0
FACILITY NAME: IL, 14 ^
L.DlailI. klirtit - "EDOnZ I� SAMPLING PE,R,�IlOD: 0 July-December [6 January-June
PERSON COLLECTING SAMPLES b11 6tV-{- J5v-vh COUNTY ,-1-7u, q UL
CERTIFIED LABORATORY V\fC6k' v uk I.Alc Ivtc, Lab# 5.‹) PHONE NO. (g L ) 133- 0 502
Lab#
ADD TO LISTSERVE? OYES ONO EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: OSA OHQW []PNA OTrout OOther
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2
pH Event Total
Collected TSSa Monthly #of Months in Tier
Outfall No. (Standard Duration Rainfall z
(mo/dd/yr OR (mg/L) Monitoring? 2 Sampling
NO FLOW)' _Units) (minutes) (in) (yi
n)
- - 6-92 100 - - - -
I 5 -i0L- 1 lv (fi, ci 8 3 , I 1p D 0 .51 " NO N t h
nn
ptip._- g �1..,
JUN 1 0 2016
CFN T PL11 FILES
DWR SECTION
' 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/I,except when discharging to ORW,HQW,Trout,and PNA waters where they are SO mg/I
°For each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge
Permit Date 7/1/2011-60/30/2016 Last Revised 7/13/11

Part B Veh,,.ie Maintenance Activity Monitoring Requirements for facilities using>5:, gal of new motor oil/month—averaged over a calendar year
In Tier 2
pH TPH using method Total Suspended Event Total New Motor Oil # of Months
Outfall Date Samplea Monthly
(Standard 1664A SGT-HEM Solids Duration Rainfall Usage in Tier 2
No. CollectedUnits) (mg/L) (mg/L) (minutes) (in) (gal/month) Monitoring? Sampling'
(mo/dd/yr)1 (y/n)
6-92 15 100'3 - - - -
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL(INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO x
HAVE YOU CONTACTED THE REGION? YES ❑ NO I
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 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 are that there e significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations"
(Sign lure of Permi tee) (Date)
Pern to Date 7/1/2011-60/30/2.016 Last Revised 7/13/11
Page 2 of

:Y 'C.-
C.- .in c.
. POST OFFICE BOX 1056 • #5 PINEWOOD PLAZA DR.
GRANITE FALLS,NORTH CAROLINA 28630
[phone]
SAMPLE: Loven -Boone COLLECTION DATE: 5/20/2016
PERMIT#. COLLECTION TIME. 17:45
ADDRESS: Loven Ready Mix RECEIVED DATE: 5/23/2016
P.O. Box 155 RECEIVED TIME: 12:26
Pineola, NC 28662
REPORTED: 5/26/2016
ANALYSIS i
f
ANALYSIS EFFLUENT UNITS DATE ANALYST
TSS 31 mg/L 5/24/16 jrg
LOG ID: 1605-355 REPORTED BY: NC CERTIFIED LAB#50
frouv--t
Tony Gragg,Lab Supervisor