NCG140101 DMR SW (4)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. Ng- 0A 0 1$ SAMPLE COLLECTION YEAR:2016
a SAMPLING PERIOD: ❑July-December ®January-June
FACILITY NAME: Chandler Concrete Company- Boone Plant 501
PERSON COLLECTING SAMPLES: Randy Carroll COUNTY Watauga
CERTIFIED LABORATORY:Blue Ridge Labs Inc. Lab#275 PHONE NO. (828)355 - 4180
Lab# ADD TO LISTSERVE? DYES NO EMAIL: _
OPTIONAL INFO: DISCHARGING TO CLASS: ESA ❑HQW ❑PNA ❑Trout ['Other
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2
pH Event Total
Collected TSS Monthly #of Months in Tier
Outfall No. (Standard Duration Rainfall4(mo/dd/yr OR (mg/L) Monitoring? 2 Sampling2
NO FLOW)1 Units) (minutes) (in)
(Yin)
6-92 1002'3 - - - -
1 NO FLOW - - 1R\IF - N N/A
AUG v ',:j
CENTRAL FILES
DVVR hU(IU VV
No Qualifying discharge during the period.-
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.
ill 3 TSS benchmark values are 100 mg/I,except when discharging to ORW, HQW,Trout,and PNA waters where they are 50 mg/I. Original State
°For each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge. 0 Copy State
0 Copy - Plant
0 Copy - File
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.
H TPH using,method. Total Suspended Event ' •Total,;':, r'` New:Motor Oil #of Months
tOutfall Date•Samgle p • p ,Monthly
(Standard' 1664A SGT-HEM \,, :Solids,, Duration" ,Rainfall4''• ,' Usage NjMont in ?• in Tier 2
No'. Collected
1, Units), (mg/L) ? (mg/L),. ;(minutes), : (in) • (gal/month)', Sampling
1 -NO FLOWN N/A
-
•
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 r sponsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I
am aware that the a s' nific t penalties for submitting false information,including the possibility of fines d imprisonment for knowing violations."
l 2 /G=
(Signature of Permittee) ( te)
Permit Date:7/1/2011-60/30/2015 Last Revised 7/13/11
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