NCG140015 DMR SW (4)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14_2.2 ?---( SAMPLE COLLECTION YEAR: 7b C 6
FACILITY NAME: 5c,s At Ip G.4J c NC 014 15 SAMPLING PERIOD: I I July-December 1January-June
PERSON COLLECTING SAMPLES COUNTY 1-A-7.4y1J
CERTIFIED LABORATORY 'J ccc'( VZ-c De --(-Su Lab# I c PHONE NO. ( ) '1 .I- L)Rs/7
Lab# ADD TO LISTSERVE? I IYES L-40 EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: I ISA ❑HQW ❑PNA I (Troutther
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2
Collected pH Event Total
Outfall No. (mo/dd/yr OR (Standard TSS Duration Rainfall4 Monthly #of Months in Tier
NO FLOW)1 Units) (mg/L) (minutes) (in) Monitoring? 2 Sampling2
(y/n)
6-92 1002'3 - -
(a kW. lib 1%3 q(.4 /02 tith
RECEIVED
JUL 1 Lio
CENTRAL FILES
DWR SECTION
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/I,except when discharging to ORW,HQW,Trout,and PNA waters where they are 50 mg/I
"For each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge
Permit Date:7/1/2011-60/30/2015 Last Revised 7/13/11
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Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using>55 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 Sample4 Monthly
(Standard 1664A SGT-HEM Solids Duration Rainfall Usage in Tier 2
No. Collected Monitoring? 2
(mo/dd/yr)1 Units) (mg/L) (mg/L) (minutes) (in) (gal/month) (y/n) Sampling
6-92 152 1002,3 - - - -
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 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
a aware tha here are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
(Sigyfature of Permittee) (Date)
Permit Date 7/1/2011-60/30/2015 Last Revised 7/13/11
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