NCG140127 DMR SW (3)

GENERAL PERMIT NO. NCG1140000
CERTIFICATI OF COVERAGE NO. NCG14 -! �►
FACILITY NAME: 2
PERSON COLLECTING SAMPLES T%
CERTIFIED L1A130RATORY SJR jdl d Bt _ Lala# Z.
Lab #
OPTIONAL NFO:
Part A: Stormwater Monitorine RPnuirPmPntc
SAMPLE COLLECTION YEAR: /
SAMPLING P I D: July -December January -June
COUNTY
PHONE NO. ( ) Q
ADD TO LISTSERVE? DYES DNO EMAIL:
DISCHARGING TO CLASS: DSA DHQ•W OPNADTrout DOther
r
Outfall No.Collected
Date Sample
(mo/dd/yr OR
NO FLOW)
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
1002.3
}
,�
eo
2
!
f
t
i
-
IOr — u1junHnut, tnier'-NU FLOW" or "NO DISCHARGE" for each outfall h
2 ere. Please mai<e sure to mark the sample period above.
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.
a For each sampled measurable storm event the total precipitation must be recorded using data from an on-site rain gauge.
M
+15
_ES
ON
Permit Date: 7/1/2011-60/30/2015
Last Revised 7/13/11
Page 1 of 2

Pert R• Ve!jirlo MnintPnnnrP Artivity nnnnitnrine RPouirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample4
Collected
(mo/dcted
pH TPH using method
( Standard 1664A SGT -'HEM
Units) (mg%L)
Total Suspended Event Total
Solids Duration . Rainfall
(mg/L) (minutes) (in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(VA)
# of Months
in Tier 2
P. z
Sampling
6-92 15z
lbaz'3-
`
1 '+ ,
p
i
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 ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 clays of receipt of sample (or at end of monitoring period
i
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 alified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage thesys�.em, or
those per n directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and Complete.
am awa th t there are si icant enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(SigZature VPermfttee)
Permit Date: 7/1/2011-60/30/2015
(Date)
Last Revised 7/13/11
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