HomeMy WebLinkAboutNCG140381_DMR_20200918STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14Q 3_ _, I
FACILITY NAME: CAP. 4AI QpaJy M,'A (OACef tJ
PERSON COLLECTING SAMPLES 1i
CERTIFIED LABORATORY ftia ol��; Lab# !Z
Lab #
OPTIONAL INFO:
Part A: Stormwater MonitorinR Requirements
SAMPLE COLLECTION YEAR: ZOZO
SAMPLING PERIOD: ® July -December ❑ January -June
COUNTY WQ eC
PHONE NO. q lq )2.11 0 2 Z z
ADD TO LISTSERVE7 ❑YES FIND EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
Outfall No.
Date Sample
Collected
( yr OR
NO FLOW)
NO FLOW)
pH
(Standard
Units)
TSS
ImB/L)
Event
Duration
(minutes)
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 SamplingZ
-
-
6-9
100
-
9
3,3
Al
Q-1-2ozo
7,3
N
N
^P;Jii;F1--
n NO rwW or NO uibuiAKbt, toter "No FLOW- or "NO 1315CHARGE" 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 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.
H
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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Part B: Vehicle Maintenance Activity Monitorine Reauirements for facilities usine > 55 Lral of new motor oil/month — averaP_p_d evpr a r_alpndnr vpar
Outfall
No.
Date Sample
Collected
1
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfalla
(in)
New Motor Oil
Usage
(gal/month)
2 Tier
In InTier#
Monthly
Monitoring?
(y/n)
of Months
in Tier 2
SamplingZ
6-9
15
100 '
-
-
-
-
-
-1-2o p
-)$1
Al
a
q -t —20Z 0
'1
p
N
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 a
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: a
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:
N 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 Perfnittee)
Permit Date: 7/1/2011-60/30/2015
q-1 g-Zo
(Date)
Last Revised 7/13/11
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