NCG030505 DMR SW (2)

Semi-annu
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
CERTIFICATE OF COVERAGE N0. NCG03 O 5 5'
FACILITY NAME YEAR SAMPLE COLLECTION 1
_vrl.l l)41 I C 2D
COUNTY SAMPLE PERIOD Ma Monthly © July -Dec
PERSON COLLECTINft PLES or (month) `
LABORATORY' l�" CHARGING TO CLASS EJORW [�HQW Trout QPNA
ufi�L lab Cert. # RECEIVtU
Comments on sample collection or analysis: Zero -flow ❑Water Supply E]SA
JAN 4 2015 ®other G
Part A: Sto�mwater Benchmarks and Monitoring Results
Outfall'No.. 'Date Sample 24-hour rain4:t=
collected' amount,(mo/cld/yr) Inches3Benchmarks ===>-
r Z 12 22 H 0.35 l -I mg L_
Ouliciii, 2 win Ii r%iL I /- . — - I . -
CENTRAL FILES
DINR SECTION
PH. .
Standard units Copper
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
6.0 — 9.0 0.007 mg/L
6.1) 1n nDRI_
U No discharge this period?'
Non -Polar 0&G/
Lead Zinc Total Petroleum
Total Toxic
Hydrocarbons
Organics'
0.033 mg/L 0.067 mg/L 15 mg/L
i mg/L
ND 0.11 ND I
A%ld%
z 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.
3 The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible for a waiver of th
° See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective ben a rain gauge requirement.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacturechconductors, manufacture
applies.
semicond
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definitio
Effluent Guidelines for the facility subject -to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
n contained in the EPA
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.
tube manufacture use the definition found in 40 CFR 469.31). 22; and for cathode ray
Permit Date: 11/1/2012-10/31/2017
SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
(Signature) (Date)
Note: Results must be reported in numerical format. 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 me/L", where XX is the numerical value of the 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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
F] No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
s
Inches
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
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Pgmit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See G
�. eneral 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 SECTI
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER ATANY ONE OUTFALL? YES NO N B
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES [I NO ❑ ❑ ❑
REGIONAL OFFICE CONTACT NAME:
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 d
assure that qualified personnel properly y designed to
P p y 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 are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
Permit Date: 11/1/2012-10/31/2017
4 I -1 1
-(Date)
SWU-245, last revised 10/25/2012
Page 3 of 3