NCG120042 DMR SW (3)

n�
S,emkannuaUStorm, WMer DistNtroe. M'onitorinp Report
for North Carol'in'a Division of Water Qu''aliN General :Permit No NCG120000
Date submitted' 1 -ll -Zottp
CERTIFICATE OF COVERAGE No' NCG12 0 C _q.
FACILITY.NA_ ME
COUNTY
PERSON COLLECTING SAMPLES.. 0 fjQy--t'E-AC-S
LABORATORY. '54U6-51A,lle ot.►b }l
lLabCert. #: qI `fo
Comments on sample collection or analysis:,
f,es�.li-s �.ae•�e �-,,5 Q\ac-eA a►�d� m�.s resu l� b�ir•
Part A: StdrmWat&-- Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR ago t f7
SAMPLE PERIOD: ❑:Jan -June: XUWDec,
Or E Monthly" (month)
WSGHARGING.TO'CLASS, []ORW ❑HQW []Trout []PNA
Y ❑Zero -flow []Water Supply ❑SA.
-gOther GL -0,s5 G
JAN 14 2016
PLEASE,REMEMBERITO'SiGN o4fl-IE`REVERSE 4
CENTRAL FILES
DWR SECTION
Outfall No.
Date Sample '24 hour;rainfall
Collected;amount;.
.3 chemical•Oicygeri,Demand. v•' Fecal,Coliform- ,TdWa Suspencled'Solids
Inches: ,
G.
Benchmarks =_=> 120 mg/L 1000E'count per iod�hiL "" Apo mg%Lor 50 mg/L
'Month lysampling (instead'of semi-annual)'mUA begin With:the,second consecutive benchrriark.exceedance,-for th:e same parameter at the same outfall.
Z
For sampling periods With no -discharge at'any single outfall, you ;must still submit this:discharge monitoringreport-with a.checkmaek here:
3The total precipitation mustbe`recorded usingdata from anon=site eain_gauge:- Unattendedssites "maybe eligible f6r,,a-W6iver 6f 'h ra h,,,' ge requirement.
' See General Perrnittext, Table 3, identifying the especially sensitive receiving water'classifications''whe'r'e the more: protective benchmark -applies:
Note: Results rnustbe,reported in numerical format:. For:example; do not report Below Qetection�Limit, BDL; <PQL, Non -detect, ND, or other similar non-
numerical format. When results,arebelow.the applicable'limits,,thdV-must be reported in the, format "<XX mgh'" where XX is the numericaLvalue ofthe
detection1imit; reporting limit, etc. in -m /L Coriversel ,wherefecal;coliform results eceed the dution u
ppr Ii, repot >X
Note if you:report a.samp/e iratue in excess3bf the benchmark, you must imp/ement Tier 3. Tier 2,: orfiier 3,responses See General Permit text:;
Permit Date: 11/1/2012-10/81/20'17 SWU-248, last rewsed 10/25/2012
Page ;of.2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑.No discharge this period?'
Date Sample
Outfall No.i
"collected
(mo/dd/yr)
24-hour ra.infall
amount,
3
Inches
Non -polar 0&G/TPH by
EPA 1664 (SIST-HEM)
Total Suspended Solids
pH
Benchmarks =__>. -
-
15 mg/L
100 mg/L or 50 mg/L°
6.0 — 9.0'SU
SQo-�T v0 25i
o
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:
o A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
0 2.EXCEEDANCES INA ROW°. FOR THE'SAME PARAMETER AT'THE'SAME.OUTFALL TRIGGER TIER2 REQUIREMENTS: SEE'PERMIT PART II SECTION B.
• TIER.3; HAS -YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE'DWQ.REGIONALOFFICE? YES ,❑ NO ❑
REGIONAL OFFICE'CONTACT.NAME:.
Mail anoriainal and`one copvof this DMR; including all No Discharge"_reports, within 30 days of receipt.of the lab results tor at end of monitorirng°perio_d
inthe 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 SION.THIS CERTIFICATION FOR AWINFORMATION REPORTED.:
I.certify, under penalty oflaw, that this document and all attachments were prepared under my direction or supervision in accordance with:a systemtdesigned to
assure that qualified .person nel:properly:gather and`evaluate.the information submitted. Based on my inquiry of the person'orpersons 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 subrnitting-false information,, including'.the possibility of fines and imprisonment'i6r knowing"diolat-ions.,i
(Signature of
Permit Date: 11/1,/2012-10/31/2017
-��-��p
(Date)
SWU-248,'1ast revised 10/25/2012
Page of_2.

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG120000
Date submitted SAS -1 , 2-ot b
CERTIFICATE OF COVERAGE NO. NCG12 O O4_
FACILITY NAME . yte�`-tk (Zo"
COUNTY 1:4-p-e_kt,
PERSON COLLECTING SAMPLES —IA-
LABORATORY .{esus Nt Lab Cert. # C)
Comments on sample collection or analysis: (�
c-
5po- 5" P05 a\
7 Coo o,o C_ to o A -A
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2 ° t5
SAMPLE PERIOD ❑ Jan -June E July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow [:]Watersupply [:]SA
Other G taS5 C.
PLEASE REMEMBER TO SIGN ON THE REVERSE -)
❑ No discharge this period?'
Outfall No,
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches;
Chemical Oxygen Demand
Fecal Coliform Total Suspended Solids
Benchmarks =__>
_
-
120 mg/L
1000 count per 100 mi.. mg/Lor 50 mg/0
500—
t21 Zot5
t -Z5
54
6000 (tel
500-5-1
(Z 0(5
1,Z5
4
(coca
Soo -S -h
Z l Zoly
TeSfO.o..A--k
000
-FeSf-e
ecc.t o c�.l
3
' 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 ms/L", where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
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: 11/1/2012-10/31/2017 SWU-248, last revised 10/25/2012
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Date Sample
Outfall No. collected'
(mo/dd/yr)
24-hour rainfall
amount, Non -polar O&G/TPH by
Inches EPA 1664 (SGT -HEM)
Total Suspended Solids
pH
Benchmarks
15 mg/L
100 mg/L or 50 mg/L4
6.0 — 9.0 SU
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 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 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? 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 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 significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date: 11/1/2012-10/31/2017
(— 7- Zo(5
(Date)
SWU-248, last revised 10/25/2012
Page 2 of 2