NCG140423 DMR SW (7)

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STORMCATER DISCHARGE OUTFALL ((SDI) e Secr amAnnuail MO II u t ,[ EIG FOAM
G d
GENERAL PERMIT NO. NCG1400©0
"��`p5�"Ir;.t� _` ,P,�p-- SAMPLE COLLECTION YEAR: ��(�� `'�
FACILITYCERTI
t=1CATE OF COVERAGE— NO.�1 � `'�- SAMPLING PERIOD: July-December ; ]January-io�ne
NAME: t^l Sl ,.1 +� ! - l COUNTY •_G fix- I---)
PERSON COLLECTING SAM"LES A •1� ` �' , PHONE OUNT NO. E�' ) �� J-/..L . /�4 ,
CERTIFIED LAt30RATORV Lab# ADD TO LISTSERVE?OYES ONO EMAIL: I
Lab# DISCHARGING TO CLASS: OSA ❑HQW ❑PNA []Trout: Other
OPTIONAL INFO:
Part A:Stormwater Monitoring Requirements In Tier Date Sample H Event Total o TierMonthly #of Months iroz ler
Collected P TSS Duration Rainfall v 2 Sampling
Outfall No. (Standard (mg/L) Monitoring.
(mo/dd/yr OR Units) (minutes) (in) NMNO FLOW)1 11 2 - - -
- r )1/ 6-9 1002.
16
CEI T' '
el
e sure to mark
e
le
od
ove.
1 If"NO FLOW"or"NO DISCHARGE,Enter"NO FLOW"or"NO DISCHARGE"
t '(for pH)for , mil ust impre.lement thelease cTier 1 or Tier 2 reisponsesin thelGenebal Permit.Tier 2
2 If a value is In excess of the benchmark,or outside the benchmarkrange
Monthly sampling shall b 100 mg/I,ne l 3 consecutive e except when discharies are ging to below
ORW,HQW,Trout,andrk rwithin the PNA waters bwhere they are 50 rng/I.
3 Tor benchmarkpvaluesmare
4 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 Page 1 of 2

( Monitoring Requirements for facilities using>55 gal of new motor oil/month—averaged over a calendar year.
Part R: Vehicle IUleintenance Activity In Tier 2 it of Months
Event Total New Motor Oil Monthly in Tior
pH TpH using method Total Suspended Duration Rainfall4 Usage ilAoreitoring? Sampling2
Outfall ®ate Sample a 5ol'eds m (gal/month) (von)
2
Collected (Standard Z669�SGT-HEM (mg/L) (minutes) (� )
No. Units)
(on®/dd/yr)1 �r�
6-92
1002'3 -
MIN
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OIIIIIMINIIIINIIIIIIIMIIIIIIIIMIIIIIIIIMNIINIIII 11111111111111111111111.111111111
IIIIIIIIMINIIIIIMIIIMMIIIINIIIIMIIIIIIIIIMIIIIIIIOIIIIIIIIIMIIIIIINIIIIIIIHIMIII
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MIIIMIIIIIIINIIIIIIIIIMIIIIIIIIMIIIIIIIIIMIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIII
1.1111.11111111111111111111111111111111111111111111111111111.111111111.111111111101111111111111111111111111.1111111111
RK EXCEEDS ES AT ANY ONE OUTFALL(INCLUDING VEHICLE MAINTENANCE)? YES 0 NOV
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK ES 0 N 0
HAVE YOU CONTACTED THE REGION?
REGIONAL OFFICE CONTACT NAME:
d
Mail Ori:inal and one cos of this DMR
includin: all"No Flow" &"No Dischar:e"retorts within 30 da s of recei•t of sam.le or at end of monitorin: ,erio
In case of"No Fl(mw")to:
Division of Water Quality
Attn:DWQ Central Files
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
that this documentANY and all attachments were prepared under my direction or supervision in accordance with a system designed to
YOU MUST under penalty
y of law, iINFORMATIONandall REPORTED:
we of the personni persons who manage the system,or
"I certify,equalified e law,
assure that personnel properly gather and evaluate the Information submitted. Based on my inquiry
e
nd
,true,
those persons directly responsible for gg
atherin the information,the information submitted is,to the best of
my wledge and belieffor knowing ccatte,and complete. I
am aw- - hat they rz significant penalties for submitting false information,including the possibility®� of�fines���J`P
(Date)
gnature of P- mittee) Last Revised 7/13/11
Page 2 of 2
Permit Date:7/1/2011-60/30/2015