NCG140106 DMR SW (3)

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STORMWATER DISCHARGE OUTFALL (SDO) - Semi-Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COV RAGE NO. a \ . W SAMPLE COLLECTION YEAR: r 0/(p
' SAMPLING PERIOD: ❑July-December [�January-June
FACILITY NAME: r S r �c�le� COUNTY l /4ci # —
PERSON COLLECTING-SACNIPLES ) 6 %l .�� r��--
Lab# PHONE N0.(a?S2) �/'/ �i
CERTIFIED LABORATORY ADD TO LISTSERVE?DES ONO EMAIL:
Lab# DISCHARGING TO CLASS: EISA ❑HQW ❑PNA ['Trout ❑Other
OPTIONAL INFO: -. - - -
Part A:Stormwater Monitoring Requirements
Date SampleIn Tier 2
pH Event Total
Collected TSS Monthly #of Months in Tier
a
Outfall No. (Standard Duration Rainfall Monitoring? 2 Samplings
(mo/dd/yr OR Units) (mg/L) (minutes) (in) WO
FLOW)
1- - 6-92 1002'3 - - - -
0 /i.....,.,,--2/.0 6.}__
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1 If"NO FLOW"or"NO 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/l.
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 I 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.
In Tier 2
pH TPH using method Total Suspended Event Total New Motor Oil #of Months
Outfall Date Sampleo Monthly
(Standard 1664A SGT-HEM Solids Duration Rainfall Usage in Tier 2
No. Collected Units) (mg/L) (mg/L) (minutes) (in) (gal/month) Monitoring? Sampling
(mo/dd/yr) - (y/n)
6-92 '152 100 - - - -
- r\I 0 . AD
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HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL(INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO E
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 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 ko
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 "'
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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 Ln
am away tha her are ' Hifi enalties for submitting false information,including the possibility of fines and imprisonment for knowing violations." o
oN
(Signature of Permittee) ! (Date)
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Permit Date:7/1/2011-60/30/2015 Last Revised 7/13/11 0 •
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