HomeMy WebLinkAboutNCG140124 DMR SW (4) -46w---- MWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
1', SAMPLE COLLECTION YEAR:
CERTIFICATE OF COV RAGE NO. N -G14'��7.L. ';"
FACILITY NAME: �i2LW��4/ j� 6/7014//Z-077---w---
/L0 71�- SAMPLING PERIOD: ❑July-December "January-June
PERSON COLLECTING SAMPLES /G?-e- COUNTY GGSl/CC1I✓-D
CERTIFIED LABORATORY /12../5414. Lab# �Z PHONE NO. (02(7) 41, --6,55/
Lab# ADD TO LISTSERVE? I AYES I !NO EMAIL:
OPTIONAL INFO: DISCHARGING TO CLASS: OSA ❑HQW I IPNA ❑Trout ❑Other
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2
pH Event Total
Collected TSS4 Monthly #of Months in Tier
Outfall No. (Standard Duration Rainfall 2
(mo/dd/yr OR (mg/L) Monitoring? 2 Sampling
Units) (minutes) (in)
NO FLOW)1 (y/n)
- - 6-92 1002'3 - - - -
41 --PrP-6 6/46q 6, 52- civc2 / / A/
RECEIVED
JUN 1 6 ZUib
rENTDL FILES
DWR SFCTIOr\I
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.
4 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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-"N --
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 Units) (mg/L) (mg/L) (minutes) (in) (gal/month) Monitoring? Sampling2
(mo/dd/yr)1 w (Y/n)
;l
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
am a are that there are s gni 'cant penaltie for submitting false information,including the possibility of fines and imprisonment for knowing violations"
r id. �-/3-�0/( '
Si nature of Permittee) (Date)
g ( )
Permit Date:7/1/2011-60/30/2015 Last Revised 7/13/11
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DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH,ON
AVERAGE,IN THE CALENDAR YEAR?
ot Yes 0 No (If yes,complete Part B)
Part B:Vehicle Maintenance Activity Monitoring Requirements
OutfallDate 00400 00556 00530
No. Sample Collected, Total Rainfall, New Motor Oil Usage, pH, Oil and Grease, Total Suspended Solids,
mo/ddlyr- inches Annual average gal/mo Standard units mg/L mg/L
Benchmark* - - 6.0—9.0 30
100*Note:If you report a value in excess of the benchmark value,or outside the benchmark range(for pH),you must implement Tier 1 or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn:Central Files
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B:
"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 there are significant penalties for-submitting false_information,including the .
possibility of fines and imprisonment fQr knowing violations."
_ 2(/ 2/cd-
(Signature of Permittee) ate)
SWU-245-072808
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STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
"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 there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
go,.. ,,, 6 - i g- 1/
(Signature of Permittee) '''''-6 (Date)
Form SWU-255-072502
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