NCG210408 DMR SW (3)

Semi-annual Stormwater Discharge Monitoring Report
fior_ North Carolina DEMLR General Permit No. NCG210000
Date submitted 1-7—/(a
CERTIFICATE OF COV RAGE O. N G 1 a Ci _S
FACILITY NAME
COUNTY �° n4gAAt
PERSON COLLECTING SAMPLES `� '96 A
LABORATORYAAtJ ZA-RS Lab Cert. # Z,2
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 20/j__
SAMPLE PERIOD ❑ Jan -June ZJuly-Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW .OHQW ❑Trout ❑PNA
OZero-flow ❑Water Supply ❑SA
Other e JW A/S"/
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
"No discharge this period?`
k"! '
;. l
M iii
Am N
z0 C
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.
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, 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: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area. Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
Y;I No discharge this neriod?'
Outfall No.
Date Sample
'Collected"
(mo/dd/yr)
247hour rainfall
amount,
Inches'
Non -polar O&G by. EPA
1664 (SGT -HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/,L
100 mg/L or 50 mg/L°
Footnotes from Part A also applyto 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:
o 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 F-1NOF-1IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES F-1NO ❑
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 monitorina period
in the case of "No Discharae" 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 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 significt penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
C
(Signature ofPermitte
(Date)
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL.• -SUMMARY "DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year_/�
Individual NPDES Permit No.NCS[:][--]F-]F-][-]Flor
Certificate of Coverage (COC) No. NCG951_1�®0®
This monitoring report summary of the -calendar year should be kept on file on-site with the facility SPPP.
Facility Name: q -k.- r2lso YL
County:' 2cNGs.
Phone Number:( .fes) 75/7- Total_no. of SDOs monitored
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 DWQ to reduce monitoring frequency . ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? -Yes ❑ No ❑
,
..Parameter, (u,riits)
Total
�Ramfall, � _
Benchmark -N/A .
W��_m
.y ."g ,<..� _, , t„:: . in
3 .::4” >•':.s .s ;.tea_ Date Sam le... •_. t � � ... ,. ��� �. � � . ��,� �. � 01
�, �N.... .� �,.;,,.. e'�,r,t ,ash`' >w ., au ,: r : ,.. Via, •:. � � �" �`� , , ��� a�.,��: - „ u . ,a' � �, �°��':�, au.. �,
�"��v� u�s ,iw,.x ?� a���T� >�r,.,,.�k_i, ,a�`+_ .,.i.. � ��,Y4 ,��l�a. „r,.a$», ,xYnM� ..� _.?.�,:�?r,?<.<.4�`rr:v a:4,,.e��,�+�k,,..a�.x��� �;t�w.exr r„�,..,»1,k'✓�a.a .>� T,k,'�` u.r �,�,�`�`
SWU-264 - Generic Annual DMR
Last revised 5/17/2013

l
Additional Outfall Attachment
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 DWQ to reduce monitoring frequency ❑
Other.
Was this 'SMmonitored because of vehicle imaintenance activities?, Yes 'E] NoTl ,
�a ` Parameter.;.(Unlfs)-
�
Total r t
,
Benchmark N/A .
e
4.:,
.:.Collected
.s:..,,. ,.,...... .:�.
.r
Y'—
SWU-264 - Generic Annual DMR
Last revised 5/17/2013

l
" 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 pi&operlygatherand 'evaluate the information --submitted. .Based on my inquiry of the person
or persons who rhanage 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. l am aware that there are significant penalties for submitting false information,
including the possibility of fines and_iRiprisonment for knowing violations."
11
Signature X
Date /! %
For:gpestions, contact your, local Regional Office:.
DWQ Regional Office Contact Information:
2090 US Highway 70
Swannanoa, NC 28778
[phone]
3800 Barrett Drive
Raleigh, NC 27609
[phone]
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
943 Washington Square Mall
Washington; NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
ID
[phone]
r"� ` TQ pses2r�ri? rc�deC,;
{t c ani, eMa-rres•
Nor7h:G�roii-, s v�rF�c
SWU-264 - Generic Annual DMR
Last revised 5/17/2013