NCG140082 DMR SW (4)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000 / Orig—State
0 Copy—State
0 Copy—Plant
CERTIFICATE OF COVERAGE NO. NOGSMOTeMit SAMPLE COLLECTION YEAR:2016 0 Copy-File
FACILITY NAME: Chandler Concrete Co.—Greensboro PIt 102 SAMPLING PERIOD: ❑July-December ®January-June
PERSON COLLECTING SAMPLES: Ashe Dames COUNTY Guilford
CERTIFIED LABORATORY:Pace Analytical Lab#633 PHONE NO. ( 336) 297 - 1179
OPTIONAL INFO: ADD TO LISTSERVE? OYES ENO EMAIL: _
DISCHARGING TO CLASS: OSA ❑HQW //PNA ❑Trout ►1 Other: WS-IV,
NSW
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2
pH Event Total
Collected TSSa Monthly #of Months in Tier
Outfall No. (Standard Duration Rainfall4
(mo/dd/yr OR (mg/L) Monitoring? 2 Sampling
NO FLOW)1 Units) (minutes) (in) (y/n)
- - 6-92 1002'3 - - - - - i �t
1 No Flow - - - N N/A ', �
AU G i ti`s'`
GDVVRSEC`TtON
ES
No Discharge Observed during this period -
There was evidence that a discharge had occurred but a qualifying sample
could not be obtained
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>S5 gal of new motor oil/month—averaged over a calendar year.
InTier 2
Outfall Date Sample pH TPH using method Total Suspended Event Total a New Motor Oil Monthly #of Months
(Standard 1664A SGT-HEM Solids Duration Rainfall Usage in Tier 2
No. Collected Units) , (mg/L) (mg/L) (minutes) (in) (gal/month) Monitoring? Sampling2
(mo/dd/yr)1 (Y/n)
-
- 6-9� 152 100Z'3 - - - -
NI/A*
*Vehicle Maintenance Not Performed at this Location
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
am aware that th re signi ' a t pe 'ties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Da e)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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