NCG240005_MONITORING INFO_20200115

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v UU5
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ L v
YYYYM M D D

Quarterly Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG240000
Date submitted I c>
CERTIFICATE OF COVERAGE NO. NCG 4Q V ,Q S�
FACILITY NAME
COUNTY�,�0. ►mow /
PERSON COLLECTING SAMPLES G lG
LABORATORY Lab Cent. #
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR '�xn 1i
SAMPLE QUARTER ❑ Jan -March ❑ April -June ❑ July -Sept [NOct-Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW .. ❑HQW ❑Trout ❑PNA
RECEIVE® ❑Zero -flow ❑Water supply ❑SA
Other k L l,,3
JAN 15 2020
CENTRAL FILES
DWR SECTION j
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i iontiiiy sampling luuteau of quarterly) must begin with the second consecutive benchmark exceedance for the.same parameter at the same outfall.
Z The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
3 For sampling periods with no discharge, you must still submit this discharge monitoring report with a checkmark here.
the TSS benchmark value is 100 mg/L; except when discharging to ORW, HQW, Trout, and PNA waters in which case the benchmark is 50 mg/L.
-4 -
Permit Date: 10/1/2011-9/30/2016 Last Revised.12/02/11
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Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
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Footnotes from Part A also apply to this Part B
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART It SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES [—]NOD
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring period
in the case of "No Discharge" reports) 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 for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
Permit Date: 10/1/2011-9/30/2016
( ate)
Last Revised 12/02/11
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