NCG170154_MONITORING INFO_20150908

STORMWATER DIVISION CODING SHEET
NCG PERMITS .
PERMIT N0.
FDOCTYPIE
❑HISTORICAL FILE
%MONITORING REPORTS
DOC DATE
❑ � �i � J � /Ok
YYYYMMDD

North Carolina Division of Energy, Mineral, and Land Resources
SEMI-ANNUAL STORMWATER OUTFALL DISCHARGE MONITORING REPORT DMR
Vehicle Maintenance Activities Only
Date submitted
CERTIFICATE OF FACILITY NAME COVERA ; 0. NCG'�QLRECEI SAMPLE COLLECTION YEAR a0 ii
j E®
COUNTY d k sEP 0 $ 2Q
PERSON COLLECTING SAMPLES PPQI V 1 LEASE REMEMBER TO SIGN ON THE REVERSE -�
LABORATORY Lab Cert. # A 44 CENTPAL FILES
DWR SECTION
Vehicle Maintenance Activity (VMA) Stormwater Monitoring Results: Only for facilities using an average of > SS gal of new motor oil per month.
ll
TotoI event rainfall' e 3 _ or ❑ No discharge This period-'
Outfall No.
Sample
Collected,
mm/dd/yr
Total Suspended
Solids (TSS), mg/L
Non -polar O&G/TPH, mg/L
(Method 1664 SGT-HEM)
(if applicable)
Oil and Grease, mg/L
(if applicable)
pH, Standard units
(if applicable)
New Motor Oil Usage,-
Annual average gal/mo,
Benchmark
-
100 or 50
15
30
Within 6.0— 9.0
-
LS
W1
1 The total precipitation must be recorded using data from an on -site rain gauge.
Z For sampling periods with no discharge at any outfall.s, You must still submit this discharge monitoring report with a checkmark here.
3See General Permit text that identifies the especially sensitive receiving water classifications where the more protective TSS benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or any 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
laboratory's detection limit, reporting limit, etc. in mg/L.
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 MONITORING RESULTS:
• A single benchmark exceedance triggers TIER 1 REQUIREMENTS. See permit PART 11 SECTION B or C.
• Two exceedances in a row for the same parameter at the same outfall trigger TIER 2 REQUIREMENTS.
• TIER 3: Has your facility had four or more benchmark exceedances for the same parameter at any one outfall? YES ❑ NO
IF YES: Have you contacted the DEMLR Regional Office? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
SWIJ-254 Vehicle Maintenance Activities DMR Last Revised: August 11, 2014
Page I of 2

14ftil an original and one cog2y ot this DMR including all "No Discharge" reports, within 30 days of receipt of the lab results or at end o
monitoring period in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 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. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
(Signature of Permitte
/15
(date-)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/lr/npdes-storrnwater
SWU-254 Vehicle Maintenance Activities DMR
Las! Revised: August 11, 2014
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