NCG140084 DMR SW (3)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000 ,/Orig-State
0 Copy-State
0 Copy-Plant
CERTIFICATE OF COVERAGE NO. ' G6414 "%, SAMPLE COLLECTION YEAR:2016 0 Copy-File
FACILITY NAME: Chandler Concrete Co. -Randleman Plant#110 SAMPLING PERIOD: ®July-December ❑January-June
PERSON COLLECTING SAMPLES: Ronnie Faulkner COUNTY Randlolph
CERTIFIED LABORATORY:Pace Analytical Lab#633 PHONE NO. (336)498- 8209
OPTIONAL INFO: ADD TO LISTSERVE? EYES NO EMAIL: _
DISCHARGING TO CLASS: ESA ❑HQW ❑PNA ❑Trout /Other: C
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 Sampling
NO FLOW)1 Units) (minutes) (in) (y/n)
- 6-92 1002,3 - - - -
1 NO FLOW N N/A
2 NO FLOW N N/A
grce
is ILr
No Discharge Observed during this period
AU u U X LUIb
CENTRAL. Fll PS
[WR 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.
TSS benchmark values are 100 mg/I,except when discharging to ORW, HQW,Trout,and PNA waters where they are 50 mg/I.
a 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 Samplea 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)i. (y/n) Sampling
6-92 152 1002'3 - - - - -
N/A *
*Vehicle Maintenance Not Performed 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 direc y responsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I
am aware th a are significant penalties for submitting false information,including the possibility of fines .n imprisonment for knowing violations."
(Signature of Permitte (o ate)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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