NCG120103 DMR SW

emi-annual
I
r Discharge Monitoring Rem
for North Carolina Division of Water Quality General Permit No. NCG120000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG12 a j & _7
FACILITY NAME 48,N;k
COUNTY �,p,Q,t,N v
PERSON COLLECTING SAMPLES
LABORATORY i > Lab Cert. # *A
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
Outfall No. Date Sample 24-hour rainfall
Collected' amount,
(mo/dd/yr) Inches3
Benchmarks =__>
W /
SAMPLE COLLECTION YEAR _ oA0/T
SAMPLE PERIOD ❑ Jan -June [ my -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEIVED i❑Zero-flow [Water Supply []SA
OCrt 16 2015 ❑other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE
0VVR SECTION
Ej No discharge this period?'
Chemical Oxygen Demand I - Fecal
120 mg/L 1000 count per
S tea%/_ > ZMA ­ .
Total Suspended Solids
mL I 100 mg/L or 50 mg/L
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report; with a checkmark here.
4The 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.
° See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQI , Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format "<XX me/L" ! where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limilt, report the result as >XX" .
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 11/1/2012-10/31/2017 I SWU-248, last revised 10/25/2012
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Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
I
F] No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G/TPH by
EPA 1664 (SGT -HEM)
Total Suspended Solids
pH
Benchmarks =__>
-
-
15 mg/L
100 mg/L or 5� mg/L"
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
See General Permit text.
• 2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEEjPERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ ,
REGIONAL OFFICE CONTACT NAME:
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 oe, persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best, of my knowledge acid 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."
(Sig ature of Permittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-248, last revised 10/25/2012
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