NCG140328 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR
Calendar Year Zd/� CM D
Revised 9/17/2014
A ►i 1 n 1(11 C,
41 JHiv 1 P LVIV
General Permit No. NCG1 0000 CENTRAL FILES
Certificate of Coverage No. NCG0B 3❑©®❑ DWR SECTION
This monitoring report summary is due to the DEMLR Regional Office no later than November 1 of
each year.
Facility Name: leo)e (i t jAleYJC—
County:
Phone Number: (!�3 lei /„ 6 -5 L Z Total no. of SDOs monitored J
Part A. Outfall No. (use multiple sheets for multiple outfalls)
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No [D'
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No [
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
Ik
Notal Rainfall
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Benchmark N/,4
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Date SampleCollected;
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Part B. On -Site Vehicle Maintenance Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ❑
Was this outfall ever,in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑
If this outfall'.was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
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Page 12

P
"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."
Sign.
Date
Mail Annual DMR Summary Reports to:
DEIVILR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
2090 US Highway 70 i 225 Green Street 1 610 East Center Avenue/Suite 301
Swannanoa, NC 28778 Systel Building Suite 714 Mooresville, NC 28115
[phone] Fayetteville, NC 28301-5043 [phone]
[phone]
t
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WI NSTONLSALEMWREGIrON,
OFFICE'
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
Page 13
943 Washington Square Mall
Washington, NC 27889
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]

er Discharge Monitorin
for North Carolina DEMLR General Permit No. NCG1
Date submitted
CERTIFICATE OF COVERAGE NO. NCG1 Q
FACILITY NAME—+t �+ c
COUNTY ;4If-- `
PERSON COLLECTING SAMPLES
LABORATORY no I,-* 64g Lab Cert. # 6 -
Comments
Comments on sample collection or analysis:
wort DMR
-.fit GSC
SAMPLE COLLECTION YEAR 0?)/ !�_
SAMPLE PERIOD ❑ Jan -June Egl-uuly-Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
Bther (;
PLEASE REMEMBER TO SIGN ON THE REVERSE -)
Part A: Stormwater Benchmarks and Monitoring Results
❑ No discharge this period?z
Z
��w �
vu �`
� ,, 3 � al Sus ended�Sohtls
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 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.
4 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
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period?z
Date Sample 24 hour rainfall'
Outfall No ' <
Collected amoun3,
(mo/dd/yr) Inches
4
�� E q S
rMW „or
Non polar 0&G by EPA b Total Suspend Solids"A"
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)� max,,
1664 (S THEM Yom;.
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 O_NE-OUTFALL? YES ❑ NO ffr"'
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 (or 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 there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of
ermit Date: 10/1/2014-9/31/2019
(Date)
SWU-252, last revised 9/17/2014
Page 2 of 2