NCG240004_MONITORING INFO_20191010

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v uc dy o l7�
DOC TYPE
❑ HISTORICAL FILE
J MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

RECEIVED
OCT 08 2019 Quarterly Stormwater Discharge Monitoring Report
CENTRAL FILEfgr North Carolina Division of Water Quality General Permit No. NCG240000
DWR SECTION Date submitted I o1 14 .11 Cl
CERTIFICATE OF COVERAGE NO.'' �``jj��CG24Q O O
FACILITY NAME //%�r'if/� 1�rll-a+ Z
COUNTY S�m.2SOd1
PERSON COLLECTING SAMPLES
LABORATORY
Lab Cert. N
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
SAMPLE QUARTER ❑ Jan -March ❑ April -June July -Sept ❑ Oct -Dec
or ❑ Monthly' (month)
DIJZ�IftTrejLA 5 ❑❑OZero [:]HQW
❑W F]Tr ut [:]PNA
OCT 10 2019 [96ther�0
CENTRAL FILES
DWR SECTION
Total event rainfall or ['No discharge this period
(
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y
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701i107 ..g/�
RA0i9� ,
Monthly sampling (instead of quarterly) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
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, HOW, Trout, and PNA waters in which case the benchmark is 50 mg/L
Permit Date: 10/1/2011-9/30/2016 Last Revised 12/02/11
Page I of - -

• 1115 nc>uraa. uniy IVJ 1da1Iues averaging > SS gal Ot new mo
........... ... . — .— apV.y w uno 1111 o
for oil/month.
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.
o TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original 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. I
am aware tbet�there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
� � e
(Signature of Permittee)
o y I 1
(Date)
Permit Date: 10/l/2011-9/30/2016 Last Revised 12/02/11
Page 2 of 2

Quarterly Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG240000
Date submitted I b�q IT_
CERTIFICATE OF COVERAGE ND.�P�CG24Q 0 0 SAMPLE COLLECTION YEAR
FACILITY NAME��iff� //C�� kr/ SAMPLE QUARTER []Jan
-March ❑ Aprll-June �ly-Sept ❑Oct -Dec
COUNTY So7/r�pSovf or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
LABORATORY Lab Cert. # ❑Zero -flow ❑Water supply [:]SA
Comments on sample collection or analysis: [they
iviommy sampung tmsteaa or qua rteriyl must oegm wan the secono consecutive Dencnrnarrc exceeue nce wi LIM bdmc Poi diucwi a< we Dolt vauo 11.
2The 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.
' 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.
Permit Date: 10/1/2011-9/30/2016 Last Revised 12/02/11
Page 1 of 2

or oil/month.
rvvmviub uun, ran A aisu apply to this Fart 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 II SECTION B.
o 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:
Mail an orialnal 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. I
am aware Ptallhere are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
0�(1
(Date)
Permit Date: 10/1/2011-9/30/2016 Last Revised 12/02/11
- Page 2 of 2