NCG140366 DMR SW (3)

RECEIVED
NOV W lMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
CENTRAL FILES GENERAL PERMIT NO. NCG140000
DWR SECTION
ao( 6
CERTIFICATE OF COVERAGE NO. NCrobillgiaigAbAs SAMPLE COLLECTION Y' R: •
FACILITY NAME: PkT co 1.1 c2eiQ. MI.1.1(cam lA e . SAMPLING PERIOD: rg July-December f anuary-June
PERSON COLLECTING SAMPLES ICP A1N'A Pa(zfzatri COUNTY kJil.CSL�
CERTIFIED LABORATORY M(C(?3 C(?-OM Lab# (( PHONE NO. a2s ) ,q3, OSOQ Q
Lab# ADD TO LISTSERVE?DYES LINO EMAIL: �Xc^
OPTIONAL INFO:
DISCHARGING TO CLASS: EISA DHOW ❑PNA ETrout Other GVS1
Part A:Stormwater Monitoring Requirements
Date Sample In Tier 2 5t--.trAZ
LX
pH Event Total _.
Collected TSSa Monthly #of Months in Tier
Outfall No. (Standard Duration Rainfall4
(mo/dd/yr OR (mg/L) Monitoring? 2 Samplingz
so�)D
Units) (minutes) (in) (y/n)
NO FLOW)1
- - 6-92 1002'3 - - - -
AO
MAIII .5N . PC) 0 - o ki Alciu E < O*lo
S4-01.4_ qi,ca
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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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
Outfall Date Sample pH TPH using method Total Suspended Event Total New Motor Oil #of Months
Collected (Standard 1664A SGT-HEM Solids Duration Rainfall° Usage Monthly in Tier 2
1 Units) (mg/L) (mg/L) „, (minutes) (in) (gal/month) Monitoring? Sampling2
(mo/dd/yr) (y/n)
s
6-92 152 1002,3 - - - - _
/17CIJ Cit , d`2gu1 is e4 o c i(? _
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDE CES 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 gat.ering the i formation,the information submitted is,to the best of my knowledge and belief,true,accurate, and complete. I
am aware that there ar- ••,.ificant .-_. - for su°mitt' g false information, including the possibility of ines a d imprisonment for knowing violations."
C 1:aa* ‘-ti /0 ' /6
(Signature of Permitt-=)
(Da e)
Permit Date:7/1/2011-.0/30/2015 Last Revised 7/13/11
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