NCG180194 - Klaussner Furniture-Pl 1 5 6 7

North Carolina Division of Energy, Mineral, and Land Resources
SEMI-ANNUAL STORMWATER OUTFALL DISCHARGE MONITORING REPORT (DMR)
Vehicle Maintenance Activities Only
REC�1v8r)
AUG 10 2015
Date submitted _T-ut-Y 2D / DWT CENTRECTION
CERTIFICATE OF COVERAGE NO. NCG / ,PG / �L/ SAMPLE COLLECTION YEAR 2611
FACILITY NAME X LA LJSSiv E iZ F urZ N iTyR E
COUNTY 9A—Do4.P)4
PERSON COLLECTING SAMPLES Sc.UA.J Fg,JZ PLEASE REMEMBER TO SIGN ON THE REVERSE 4
LABORATORY Mega -TEC 4 Lab Cert. # /6s -
Vehicle Maintenance Activity (VMA) Stormwater Monitoring Results: Only for facilities using an average of > 55 gal of new motor oil per month.
,r
Total event rainfall 2 - �! % or ❑ No discharge this period2
Outfall No.
Sample
Collected,
mm/dd/yr
Total Suspended Non -polar O&G/TPH, mg/L
Solids (TSS), mg/L (Method 1664 SGT -HEM)
(if applicable)
Oil and Grease, mg/L
(if applicable)
pH, Standard units New Motor Oil Usage,
(if applicable) Annual average gal/mo
Benchmark
-
100 or 50 15
30
Within 6.0-9.0 -
F/ /
uNL- 1 2otr
e r n
7.7
1 The total precipitation must be recorded using data from an on-site rain gauge.
2 For sampling periods with no discharge at any outfalls. 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 me/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.
FOR MONITORING RESULTS:
• A single benchmark exceedance triggers TIER 1 REQUIREMENTS. See permit PART II 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 anyone outfall?
IF YES: Have you contacted the DEMLR Regional Office?
REGIONAL OFFICE CONTACT NAME:
SWU-254 Vehicle Maintenance Activities DMR
See General Permit text.
YES ❑ NO
YES ❑ NO ❑
Last Revised: August]], 2014
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Mail an original and one copy of this DMR including all "Na 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 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 Permittee)
1-1'7-��
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/Irinpdes-stormwater
SWU-254 Vehicle Maintenance Activities DMR Last Revised: August 11, 2014
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