NCG240005 DMR SW (3)

Quarterly Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG240000
Date submitted /-
CERTIFICATE OF COVERAGE NO. NCG24 ®O O 5—
FACILITY
FACILITY NAME 6,,,e C&A r14 4 f
COUNTY C"W 4.a/
PERSON COLLECTING SAMPLES
LABORATORY Lab Cert. #
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR Z O 1 y
SAMPLE QUARTER F] Jan -March ❑ Xpril-June E]July-Sept 9oct-Dec
or ❑ Monthly'_ (month)
CHARGING TO CLASS ❑ORW �HQW Trout ❑PNA
` RECEIVED ❑Zero -flow ❑Water Supply E]SA
®Other lit! -5 / J
JAN 202015 !�
CENTRAL FILES
DWR SECTION
rart A: btormwater
quarterl th
Benchmarks
and
Monitoring
Results Total event rainfall Z or XNo discharge this period3
Date Sample
Collected'
(mo/dd/yr)
Outfall No.
TSS
Coo
Fecal Total Total Total
caliform aitrow phosphprus copper
Tota) Total
lead zinc pH
Parameter
benchmarks-= =�
100 mall
120 mg/L
1000 co14100 ml 30 mg/L 2 mg0.007 mgil
0.03 mg/L 0.047 mall. 6-9
r
Monthly sampling
(instead of
% must be
'n 'th
d
y gi wi a secon consecutive benchmark exceedance for the same parameter at the same outfall.
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.
s 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

Dart R• Vphirlp Maintenance Area Monitorine Results: only for facilities averaging > 55 gal of new motor oil/month.
- -- - -- - ---
Date Sample
collected
(mo/ddhr)
- -
outfall No.
—
pH TPH using medwd
Ib64A SGT HEM TSS
Total
Rainfall
OW*
HNo �i
Flow I Averap New ,+dolor Qil Usage
�� I
pfflwe ?�
6.9 is
Footnotes from Part A also apply to this Part B
FOR PART A AND PART B MONITORING RESULTS:
•i 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 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 o� 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 Discharae" 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 that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
of
I
Permit Date: 10/1/2011-9/30/2016
I ,
—�� -/ -
(Date)
Last Revised 12/02/11
Page 2 of 2