NCG140167 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO) = Semi:Annual-MONITORING FORM -
GENERAL PERMIT N0. NCG140000
CERTIFICATE OF COVERAGE N0. NCGn/14Q -L G
FACILITY NAME: R Ao q M;141 &;0A, -rt_
PERSON COLLECTING SAMPLES AIM CcA-- Mi
CERTIFIED LABORATORY 1�c S gk kj&1% :ca/ Lab # -3
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: A0 Is—
SAMPLING PERIOD: truly -December ❑ January -June
COUNTY hazSY-r►�
PHONE NO. (334) 40M -Aq O'7
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: []SA ❑HQW ❑PNA ❑Trout
❑Other
Date Sample
Collected
Outfall No.
(mo/dcl/yr OR
NO FLOW)'
PH
(Standard
Units)
TSS
(mg/L) -
Event
Duration -
(minutes)
Total
4
Rainfall
(in)
In Tier 2
Monthly # of Months in T'
Monitoring? 2 SamplingZ
(y/n)
- -
6-9Z
100Z,3
-
-
- -
SAY
4S ( )L
LAP
) .s—
,u
N oLF
If "NO FLOW" or "NO DISCHARGE. Enter "NO
FLOW" or "NO DISCHARGE" for each outfall here. Please make sura to mark the samnla narind nhnva
Z 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, HOW, 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.
GGElvED
pEC 16 2015
T1014
Permit
DWR
SFC
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.
Outfall
No:_
pH TPH using method'
Date Sample
(Standard 1664A -SGT -HEM
Collected'.- Units) (mg/L)
64
'Total Suspended
Solids
(mg/L)
100
In Tier 2
- Event. `-Total New Motor Oil
Duration Rainfall° Usage Monthly
(minutes) On') (gal/month) Monitoring?
# of Months,,
in Tier 2
Samplingz
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ NON
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coov 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 for3athering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there are significant p¢nalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Perm
Permit Date: 7/l/2011-60/30/2015
(Date)
Last Revised 7/13/11
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