NCG080801_MONITORING INFO_20160113

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v C& 08OSO
DOC TYPE
l HISTORICAL FILE
f/MONITORINGREPORTS
DOC DATE
❑ 01UI�oI 1,3
YYYYMMDD

tk
Semi-annual Stormwater Discharge Monitoring Rel2ort
for North Carolina Division of Water Quality General Permit No. NCGIR0000
Date submitted LUlc�11a Cc/a✓
CERTIFICATE OF COVERAGE NO. NCGgkgD s o 1
FACILITY NAME%er(/lceS
COUNTY
PERSON COLLECTING SAMPLES _ ��a r/ iO4&,1- .
LABORATORY "�GS,au✓E�a ��a��r��Ga j_ Lab Cert. # AJ< # 3
Comments on sample collection or analysis: A/C W 37ib I
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR &"' ; l ¢rra" ` —
SAMPLE PERIOD ❑ Jan-June,,ETJuly-Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow Water Supply ❑SA
❑Other a,� gtzt/4r�
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period?2
Outfall No.
Date Sample
Collected'
(ma/dd/yr)
24-hour rainfall
amount,
inches'
Chemical Oxygen Demand
Fecal Coliform
Total Suspended Solids
P
Benchmarks =__>
_
-
120 mg/L
1000 count per 100 mL
100 mg/L or 50 mg/L'
,1/S`
—7 . b
���aL/ 2•-
/2 r5�
/S o .
a-F 4 /�
��li-7
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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.
a 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, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mfz/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 limit, 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 SWU-248, last revised 10/25/2012
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
24-hour rainfall
Collected'
amount,
Non -polar O&G/TPH by
Total Suspended Solids
pH
(mo/dd/yr)
Inches s
EPA 1664 (SGT-HEM)
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/O
6.0 - 9.0 SU
o-_4tag #r r
t-/,/7 ru—
.L 6-
-7. O
5.(03
6c (-ra!f
/7 /S
L
a -
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 responses. See General Permit text.
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 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: 6/B0on %lJ /7,If,
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results !or at end of monitdrina 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. 1
am aware that there af�nifican�,penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
L""� l 3 20 / (y
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-248, last revised 10/25/2012
Page 2 of 2

CERTIFICATE OF
FACILITY NAME
COUNTY
PERSON COLLEC
LABORATORY
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG120000
No. NCG� D S D !
PLES
Lab Cert. #
Date submitted
Comments,on sample collection or analysis: n1p 3�
C d U ! /rJG ,b
C; fie, IJc_ r e_5arlSe WGS IV04 COM/9
Part A: Stormwater Benchmarks and Monitoring Results
j
SAMPLE COLLECTION YEAR 6
SAMPLE PERIOD Jan -June ❑July -Dec ft
or ❑ Monthly' (month
DISCHARGING TO CLASS ❑❑ HARRGORW HQW rout MP
R ISNA✓
❑Zero -flow Water Supply ❑SA
JUL 31 2015 ❑Other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE
DWR SECTION
❑ No discharge this period?'
Outfall No.
Date Sample
Collected)
(mo/ddJyr]
24-hour rainfall
amount,
Inches3
Chemical oxygen Demand
Yg
Fecal Coliform
Total Suspended Solids
p
Benchmarks =__>
_
-
120 mg/L
1000 count per 100 mL
100 mg/L or 50 mg/L'
�t5
6
^� ►4
N d►
U a
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.
'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.
' 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, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in -the format, "<XX mg/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 limit, report the result as ">XX".
Note.* if you report a sample value in excess of the benchmark, you must implement Tier I, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 11/1/2012-10/31/2017 SWU-248, last revised 10/25/2012
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No dischorge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3 .
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L°
6.0 — 9.0 SU
y-
- l az) i
b
1 10
la ,
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 Z or Tier 3 responses. see General Permit text.
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 II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO N-
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO M
REGIONAL OFFICE CONTACT NAME:
Mail an original and one coav of this DMR includina all "No Discharae" reports, within 30 dovs of receipt of the lab results for at end of monitorina period
in the case o "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 arej�ignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
-cP--7- 2D / 57-
(Date)
Permit Date:11/1/2012-10/31/2017
SWU-248, last revised 10/25/2012
Page 2 of 2