NCG160155 DMR SW

Semi-annual Stormwater Discha
for North Carolina DEMLR General
Date submitted
CERTIFICATE OF COVERAGE N0. NCG16 D 1 S -
FACILITY NAME J, 4 WQ070V C=Ge?P. Yi�y uG s d/4. /
COUNTY _ ..AJXL/ -l/
PERSON COLLECTING SAMPLES Lj I 4zmrm S
LABORATORYLab Cert. #
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
e Monitoring Report (DM
rmit No. NCG160000 - Asphalt
SAMPLE COLLECTION YEAR o20/5—
SAMPLE PERIOD ❑ Jan -June ,KJuly-Dec
or ❑ Monthly) (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
- > _� ❑Zero -flow ❑Water supply [:]SAf . -�► t#I..<z 30ther
NOV 16 2015
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
D::EC:N
❑ No discharge this period?'
Outfall No.
Date Sample
Collected)
(mo/dd/yr)
24-hour 'rainfall
amount,
Inches3
Total Suspended Solyds."
BenchMgrks
100 mg/L or50 mg/L'
ZMonthly 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.
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.
° 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 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, quantitation 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.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
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Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
F-1 No discharae this Deriod?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount, ..
Anches3
..Non -polar O&G by EPA
1664 (SGT -HEM)
=- -
Total, Suspended Solids
Benchmarks =__>
_ .
-
15 mg/L
100 mg/L or 50 mg/L4
Footnotes from Part A also apply to this Part B
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 SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? 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 Resources
Attn: DWR 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 tthhe1re are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(SignatureOermittee) —
9' is - av�cs
(Date)
*Nrmit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
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