NCG160091_MONITORING INFO_20110301

STORMWATER DIVISION CODING SHEET
NC6 PERMITS
PERMIT NO.
/V �'l.�/ CIO -1
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ c�17 I I � 3 �
YYYYMMDD

e ja*w�eIcl�
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year A 0 0
General Permit No. NCG160000 MAR 0 1 2011
Certificate of Coverage No. NCG1610FOEIM❑
This monitoring report summary Is due to the DWO Regional Office no later than 30QaT.s m the date
the facility receives laboratory sampling results from the final sample of the calendar year.
Facility Name* [ l
County:
Phone Number: (9 IV1 ) q Total no. of SDOs monitored
Outfall No.
Is this outfall currently In Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever In Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was In Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring'frequency ❑
Other ❑
outfall
'!
.Total Rainfall, Inches
:00530 00400
00556
TSS,'mg/L pH, sm.
Total Petroleum
Hydrocarbons, mglh
Benchmark
N/A
100 6.0 — 9.0
15
Date Sample Collected,
molddlyr
`s: , ���K
�tt �hh
1 !4
` y i'
SW U-250NCG16-051709

w-,
Additional Outfall Attachment
Outfall No. J1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No rq/
Was this outfall ever In Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was In Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
outfall
y
Total Rainfall, Inches
r„
00530 :,..
00400
00556
SS, moll.
" Hydrocarbons; mglL
Benchmark
NIA
100
6.0 - 9.0 .
15
Molddlyr P •r� r
�.: ,
`��,�s� I?� . E.. a"� ;�i ll�
� •F Ei s�:.....,.F �
;1
�� . y � �!1'#�i�,��
�'l��.� �, i .
SW U-250NCG16-051709

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG160000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE NO. NCG16®©0[J
Ji
FACILITY NAME C_•{5 It.
PERSON COLLECTING SAMPLES
CERTIFIED LABORATORY Lab #
Lab #
Monitoring Requirements j
SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days from the date
the facility receives the sampling results from the laboratory.)
COUNTY &- tffdao,�&l
PHONE NO. J I u 1 7,1A �1 a
Outfall
No.
Date
Sample Collected,
moldd/yr
Total Rainfall,
inches
00530
00400
00556
Total Suspended Solids, mg/1
pH,
Standard units
Total Petroleum Hydrocarbons, mg/1
EPA Method 1664 (SGT-HEM)
Benchmark
-
-
100
Within 6.0 -- 9.0
15
1 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.
Mail original and one copy to:
Division of Water Quality
Ann. Central Files
1617 Mail Service Center
Ralei h, 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 there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permif#ee)
aQ ,;, -, (� -5:
( e)
r_s
SWU-253-051409
Page 1 of 1

STORMWATER DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCGI60000
DISCHARGE MONrTORING REPORT (DMR)
CERTIFICATE OF COVERAGE NO. NCG16510FTM SAMPLES COLLECTED DURING CALENDAR YEAR:
(This monitoring report is due at the Division no later than 30 days from the date
the facility receives the sampling results from the laboratory.)
FACILITY NAME -:8?'''-. X-� �/V- COUNTY f
PERSON COLLECTING SAMPLES PHONE NO. '- - .
CERTIFIED LABORATORY Lab #
Monitoring Requirements � '
Outfall
No.
Date
Sample Collected,
mo/dd/yr
1 100530
Total Rainfall,
inches
.00400
- 00556
Total Suspended Solids, mg/l
pH,
Standard units
Total Petroleum Hydrocarbons, mg/l
EPA Method 1664 (SGT-HEM)
Benchmark
-
100
Within 6.0 — 9.0
15
1 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.
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:
"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."
(Signature of Pe ' ttee)
(r�
(Date)
'1'
SWU-253-051409
Page 1 of I

STORM WATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCGI60000
CERT-MCATE OF COVERAGE NO. NCGl6 0o G
FACILITY NAME n S+kvr�
PERSON COLLECTING SAMPLE(S) ,r
CERTIFIED LABORATORY(S) Ex"v `y-sTn_ AXIS- _Lab # t c�
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: \C�9 6
(all samples collected during a calendar year shall be reported no later than
January 31 or the following year) r
COUNTY _ r+mhex �QYI
PHO
(SIGNATURE OF PERM1'ITEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge
Outran
Date h
50050
00340 : },
00400 .
00556
OU545 F:
NO.
Sarntpiins
ToW
Chemical
pll �t
Oil and Grease
Total.<:h;t
°
Cnikcted
Flow,:f'wRw�
z
":S�mpe+nded
,
-A� { ; k
", i�.r ,y y iG
Demand
i
l7Viil� _
trimmzA
l-11-9
b
-o
S o
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? yes _no
(if yes, complete Part H)
Part B: Vehicle Maintenance Activity Monitorinz Requirements
RECEil,reft.
D
SUN 0 2 n98
RLGY� :
CF
Ontfall i �
DateAA1_ a'
: 0050t ^S' # .
00556 �'
01031 +
JOWV :".; :
Ii040A }7�F
L7ka .. �� !ts
No
�
SamtQle1ToW
Fib-
Oil and Grose
I,ead� ;.Total
De6erRerrts'„
New Matar Oil
Z'l.b°�"
UsarG`
Recoverable=`
AS
:.�.ECs
mddd/ tC °�
MC�,�� ��
6=
E
�tFi„
Vmo t.
L O
STORM EVENT CHARACTERISTICS:
Date S 10 q �
Total Event Precipitation (inches): i
Event Duration (hours):
(if more than one storm event was sampled)
Date
Total Event Precipitation (Inches):
Event Duration (hours);
Mall Original and one copy to:
Attn: Central Files
DEHNR
Division of Environmental Mgt,
P.O. Box 24535
Raleigh, NC 27626-0535
Page I of 2
Forni MR16

Footnotcs:
I Applies only for facilities at which fueling occurs.
2 Detergent monitoring is required only at facilities which conduct vehicle cleaning operatio s.
"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 inrormation submitted is, to the best
of my knowledge and belief, true, accurate, and complete. I am aware that there are signif nt penalties for submitting raise inrormation,
including the possibility of fines and imprisonment for knowing viola6peV1"\ r /?
(Signature of Permittee) (Date)
Ij r Page 2 of 2
I
CO
,{ CO
Form MR16

It
STORMWATER DISCHARGE OUTFALL (SDO)
VISUAL MONITORING REPORT
Certificate of Coverage No. NCG b0 �I
Facility Name:4vrh, c, C�o . -- e
County: Phone No:(a)Oi)
Inspeector. �M•}ne l
Date of Inspection:
By this signature, I certify that this report is accurate and complete to the best of my
knowledge:r­,\ it
(Signature of permiu�e or designee)
1. Outfall Description
Outfall No. l Smicaire (pipe, ditch, etc.): -�zh �cros rn
Receiving Stream: —r _
Descn'be the industrial activities that occur within the outfall drainage area:
1 _ I i - I
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor
Describe any distinct odors that the discharge may have (i.e. smells strongly of oil, weak
chlorine odor, etc.):
Page 1 of 2 911/94

4. Clarity
Choose the number which ben desmbes the clarity of the discharge where 1 is clear and 10
is very cloudy. MAY 28 ' 98
2 3 4 S 6 7 8 9 10
S. Solids
Choose the number which best describes the amount of solids in the stormwater discharge
where 1 is no solids and 10 is extemely muddy:
2 3 4 S. 6 7 8 9-1 10
6. Foam
Is there any foam in the stormwater discharge? YES hO
7. Oil Sheen
Is there an oil sheen in the stormaater discharge? YES
8. Outfall Staining
Describe any staining around the stormwater outfalh
9. Other Indicators
Describe any other obvious indicators of stormwater pollution:
NOTE: Low clarity, high solids and/or the presence of foam, oil sheens, or outfall
staining may be indicative of pollutant exposure. These conditions may warrant
further investigation.
Page 2 of 2 8l1194