NCG030098 DMR SW (10)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG03_L)
FACILITY NAME
COUNTY
PERSON COLLECTING SAMPLES.
LABORATORY RATCab Lab Cert.# 4
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION NEAR 2U i 5'
SAMPLE PERIOD ❑ Jan -June ❑ July -De
or D4Monthlyl �eCeo3 f'I" (month)
RfDISCI I3I TO CLASS ❑ORW ❑HQW []Trout ❑PNA
M.❑Zero-flow ❑Water Supply []SA
JAN [Other 6,-S�5
c WTD C FILMEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
D
No discharge this period?'
Date Sample X24 hour rainfall
p
Outfall"No
Collected amount,
(mo/dd/yr) Inches3
Total Suspended Solids
p H :
Standard units, .
Copper
Lead,'
-
Zinc.
Non -Polar O&G/
`Total Toxic
`:Total Petroleum s .
Organics
Hydrocarbons
Benchmarks!=-=> _ : i-
l00 mg/L ori50,mg/L4
6:0-9.0
0.007 mg/L ;
0:03 mg/L"
0:067 mg/L
15 mg/L 1 mg/L
01.c&..li I"z 1"1 i5- J.ZS
1 Monthlv samDline (instead of semi-annual) must
beein with the second consecutive benchmark exceedance for the same narameter
at the same n„tfall_
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.
4 See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture electronic
crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the. EPA Effluent
Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor manufacture use
the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray tube manufacture use
the definition found in 40 CFR 469.31).
PERMIT DATE: 11/1/2012-10/31/2017 SWU-24S, LAST REVISED 10/25/2012
PAGE 1 OF 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring may
be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General Permit. For
those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or stormwater
runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the solvent management plan
included in the Stormwater Pollution Preventio�Pl n."
CuL k(' U(1A1Q,/'\
Name (Print na e)
'?I.a 6j ARA(q_ef
TitlTitl (�e)
l0
ignature (D te)
Note: Results must be reported in numerical format. D 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.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month..
❑ No discharge this period?'
L ' DGollectedle t ' 24 amount falls
1
p M
OutfalhNo -
Non polar O&G/TPH by H
(mo/dd/yr) ; { Inches3.4i'' EPA'1664 (SGT=HEM),. r ,Total Suspended.Sohds p
eerichmarks > a —
*
mg/L';; 100 mg/Lor 50 mg/L _
Footnotes from Part A also apply to this Part B
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
PERMIT DATE: 11/1/2012-10/31/2017 SWU-245, LAST REVISED 10/25/2012
PAGE 2OF3

1
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 BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SE ION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC S FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES KNO ❑
IF YES, HAVE YOU CONTACTED THE DWQ RE ONAL OFFICE? YES NO ❑ TTT```"`
REGIONAL OFFICE CONTACT NAME: !',4--yy` DO ut ( I'41;;Z�-A- I If
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 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
�_
(Date)
PERMIT DATE: 11/1/2012-10/31/2017 SWU-245, LAST REVISED 10/25/2012
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