NCG140251 DMR SW

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year T aj S RECEIVED
Revised 9/17/2014
General Permit No. NCG1
CENTRA, FILES
Certificate of Coverage No. NCG1r0l[�K❑ 0©❑DWR SECTION
This monitoring report summary is due to the DEMLR Regional Office no later than November 1 of
each year.
Facility Name: epp %ac�)+ 4--y
County: Lt/ A -k t
Phone Number:
Total no. of SDOs monitored
Part A. Outfall No. 2- (use multiple sheets for multiple outfalls)
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
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 ❑
Outfiall ���
"40-1
§1 TSS,�mgiL
M�OF
Benchmark N/A
501100
A p'3 -: ,3 yy4i h atiF %
FCLA
Kt
Page I 1
Yes ❑ No [E'
Yes ❑ No []
��� Ldp•
i v jai
1h

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 ❑
i '3 4' %.'
�
� Total Rainfall
Outfall��TSS,mg/L
sCME� ��!ches��
VT
3 4
00530
rz
r� +��zldon
��
did .:4
00556
I
�
p olar0�l�
Greasemg/L
Benchmark N/A
501100
15
Page 12

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11
" 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."
SignE
Date
Mail Annual DMR Summary Reports to:
DEMLR 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]
ASHEVILLE REGIONAL>OFFIGE
FA YETTE,REGIONAL{OFFICE
1VI©URESVILEREGIONALOFFICE
610 East Center Avenue/Suite 301
2090 US Highway 70
225 Green Street
Swannanoa, NC 28778
( Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
j
I
I RAI EIGH R' EGIONALdOFFICE
WASHINGTON REGIONA'I UFFIGE
WILMINGTONxI2EGIONAL OFFICE]
! 943 Washington Square Mall
127 Cardinal Drive Extension
3800 Barrett Drive
Raleigh, NC 27609
; Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
j [phone]
[phone]
N TONSALElYI=-REGf IONAL
�'OFFICE�
E
(
I
E
585 Waughtown Street
j Winston-Salem, NC 27107
i
[phone]
i
Page 13

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG7,'0000 - Asphaj,
Date submitted Zor s i
I
CERTIFICATE OF COVERAGE NO. NCG1d0
FACILITY NAME
COUNTY
PERSON COLLECTING SAMPLES o
LABORATORY_ 1.46 Lab Cert. #
Comments on sample collection or analysis:
A6 �5rd Lt L
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
SAMPLE PERIOD Jan -June Q July -Dec
or ❑ Monthly'_ (month)
DISCHARGING TO CLASS ❑ORW F_jHQW Trout ❑PNA
[]Zero -flow ❑Water Supply []SA
[Other ) — Ns W
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
-
A-
Outfall No
`
°Benchmarks = >
Date Sample 24-hour rainfall
Collected V.:
amount, ,
"L(mojdd/yr)r aTotal Suspended Solids
$ s 100mg/L or:50 mg/L
No discharge this period?2
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z 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.
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-2S2, 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.
U No discharge this period?`
Date Sample -24-hour rainfall
r Outfall No Collected) amount,+ Non polar.0&G by EPA Total Sus ended Solids
(mo/dd/ye) Iriches3 J664',`(SGT.=HEM) p E 4
Benchmarks _, i5,mg/L 300�mg/L or`50 mg/t
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 ANYONE 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 oriainal 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."
(Date)
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2 '*