NCG140320 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. N c` 4 ' _ SAMPLE COLLECTION Y R:
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FACILITY NAME: PkT CO u Q eN, ajui t c411 114 C, . SAMPLING PEROD_: July-December anuary-June
PERSON COLLECTING SAMPLES IcQNNy PARR-2COUNTY Nibs
CERTIFIED LABORATORY M (C -0 Q(1,C Lab# I I PHONE NO. (2 5 ) (43, 0 SOQ W���
Lab# ADD TO LISTSERVE?DYES ENO EMAIL: �Q
OPTIONAL INFO: DISCHARGING TO CLASS: OSA ❑HQW EPNA ❑Trout Other NSW— C' -'
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2 `����
pH Event Total J a,
-, to TSS a Monthly #of Months in Tier
Outfall No. i LI (Standard Duration Rainfall4 so�1D�
( / R (mg/1.) Monitoring? 2 Sampling
Units) (minutes) (in) (Yin)
P!OTI143v dl'16
- - 6-92 1002.3 - - - -
CENTRAL FILES .
DWR SECTION
pc),,,h.. /00 ,(Gbi P-. . o Q 0 ki Ake. O. O
cv,vi
. _
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 13: Vehicle Maintenance Activity Monitoring Requirements for facilities using>55 gal of new motor oil/month—averaged over a calendar year.
•
In Tier 2
Outfall Date Sample pH TPH using method Total,Suspended Event Total New Motor Oil #of Months
Collected (Standard 1664A SGT-HEM .Solids Duration Rainfall4 Usage Monthly in Tier 2
(mo/dd/yr)1 Units) (mg/L) (mg/L), , , (minutes) (in) (gal/month) Monitoring? Sampling2
t (Y/n)
6-92 152 1002'3 - - - - -
- Igkt Nu\ JeKu M D Uc( ?\e..._.
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDS CES AT ANY ONE OUTFALL(INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO V
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 pro..-rly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible r gatherin: the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I
am aware that - - ,tenairolt_ n .I 1 bmitting false information, including the possibility of ines a imprisonment for knowing violations."
..•� . i- fir
(Signature of Permittee) (Date)
Permit Date:7/1/2011-60/30/2015 Last Revised 7/13/11
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