NCG210409 DMR SW (3)

Semi-annual Stormwater Discharee Monitoring Report T
for North Carolina DEMLR General Permit No. NCG210000
Date submitted
CERTIFICATE OF CO RAGE NO: NCG21D q D
FACILITY NAME AS
COUNTY Q (�
PERSON COLLECTI G SAMPLES SO 4 per,
LABORATORY &r-1 Gp Lab Cert. # CIL
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR©l�
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly' , (monthl
DISCHARGING TO CLASS ❑ORW ❑HQW EjTrout .QPNA
RECEIVED [Zero -flow OWater Supply - QSA
NOV 13 2015 her G/4 -s ss C
CENTRAL FILES • • PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is require on 5 i e N cility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.) 4�� t�Ofh
Outfall No.
Benchmarks
Date Sample 24-hour rainfall
Collected' amount,
(mo/dd/yr) Inches3
.0 7 "
Chemical Oxygen Demand,
No discharge this period?'
Total Suspended Solids
120 mg/L j 100 mg/L or 50 mg/L
9z_ PWG//— 7 /P
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
3 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
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.
° See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other si 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 aof the
detection limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmork, you must implement Tier 1, Tier 2, or Tier 3 responses. See General permit text.
Permit Date: 8/1/2013-7/31/2018
SWU-245, last revised 7/31/2013
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Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > SS gal of new oil per month.
Outfall No.I Date Sample
Collected'
Benchmarks --->
Footnotes from Part A also apply to this Part B
24-hour rainfall
amount, Non -polar O&G by EPA
Inches3 1664 (SGT -HEM)
15 mg/L
/_C
No discharge this peric
Total Suspended Solids
100 mg/L or 5o 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 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.
• 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 DEMLR REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
in the case of "No Discharge" revortsl 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
th sons directly responsibl for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
m awar that tt e are signi a t penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
/ ( // /1
of Permittee)
Permit Date: 8/1/2013-7/31/2018
(Date)
SWU-245, last revised 7/31/2013
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