NCG02 Certificate of Coverage No. Additional Outfall Attachment (make copies as needed for additional outfalls) Stormwater Discharge Outfall (SDO) No. ________ VMA Outfall? Yes No Is this outfall currently in Tier 2 for any parameter? Yes No Was this outfall ever in Tier 2 during the past year? Yes No If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency Yes, received approval from DEMLR to reduce monitoring frequency No, turbidity benchmark exceedances did not require monthly monitoring Other ___________________________________________________ Upstream Downstream New Total Turbidity, TSS, SS, (U) Turbidity, (D) Turbidity, Motor Oil Outfall No. Rainfall, NTU O&G, mg/l mg/l ml/l NTU NTU Usage _________ inches (VMA) (gal/mo.) Circle Circle N/A N/A >55 gal/mo. Stormwater Indicate NO Benchmark Benchmark average requires 0.1 Water Quality Water Quality 15 Benchmarks 100/50 50/25/10 FLOW if TSS and Non-polar Standard applies Standard applies applicable O&G monitoring Date Sample Collected, mo/dd/yr
Certificate of Coverage No. NCG02 Additional Outfall Attachment (make copies as needed for additional outfalls) Stormwater Discharge Outfall (SDO) No. ________ VMA Outfall? Yes No Is this outfall currently in Tier 2 for any parameter? Yes No Was this outfall ever in Tier 2 during the past year? Yes No If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency Yes, received approval from DEMLR to reduce monitoring frequency No, turbidity benchmark exceedances did not require monthly monitoring Other ___________________________________________________ TSS, mg/l SS, ml/l Upstream (U) Turbidity, NTU Downstream (D) Turbidity, NTU New Motor Oil Usage (gal/mo.) Outfall No. _________ Total Rainfall, inches Turbidity, NTU O&G, mg/l (VMA) Stormwater Benchmarks Indicate NO FLOW if applicable Circle Benchmark 100/50 0.1 Circle Benchmark 50/25/10 N/A Water Quality Standard applies N/A Water Quality Standard applies 15 >55 gal/mo. average requires TSS and Non-polar O&G monitoring Date Sample Collected, mo/dd/yr