NCG140124 DMR SW (2)

STORMWATFR DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF'COVERAGE NO. NCG14 &V.
FACILITY NAME: - ✓ Y
PERSON COLLECTING SAMP -ES lme-
CERTIFIED LABORATORY Lab # x,O' 2—
Lab
Lab #
OPTIONAL INFO:
Part A: Stormwater'Monitorine Reauirements
1
SAMPLE COLLECTION YEAR:
SAMPLING PTIOD:,July-December E] January. -June ���� �qLX
COUNTY .��L6/�."�aQ,•Vr<� CE
PHONE NO...r DWR
ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)
pH_.
(Standard
Units)
TSS
(mg/L)
Event
Duration
minutes)
Total ll4
Rainfa
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling
-
-
6.Sl
1002'3
-
-
-
-
v
6)
/ Zi
,d
..
1 If "NO FLOW" 6r`1'N0. 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.
' 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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i
Part B- VehiriP MnintPnanra Artivity Monitorine Requirements for facilities using > 55 sal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Samplea
Collected.
.F 1
PH.
(Standard
Units)
TPH using. method'
1664A SGT HEM .
(rng/L) ',
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier'2
Monthly
Monitoring?
# of Months
in Tier 2
2
Sampling
6-9Z'
15 -
100.,
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [:]NOD
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 sain le 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 2769.9-1617
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.
am ayvare that there are significant penalties for submitting false information, including the possibility of fines'and imprisonment for knowing violations."
I,PT Fz %141 711=4
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
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