NCG120019 DMR SW

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG120000
_.• Date submitted 1--T-
CERTIFICATE
--T-
CERTIFICATE OF COVERAGE NO. NCG12.P CJ 0 3
FACILITY NAME
COUNTY J
PERSON COLLECTING SAMPLES
LABORA'
Comments on sample collection of analysis:
Part A: Stormwater Benchmarks and Monitoring 116sults
r,
SAMPLE COLLECTION YEAR ?Clr
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly' (month) `
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RE EIVED
❑Zero -flow ❑Water Supply RSA
JAN 13 2016 ❑other
CENTRA. FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
n Ain rlicrhnrno Chic norinrl72
Outfall No.
Date Sample
Collected' .
(mo/dd/yr)
24 -how rainfall
amount,
Inches 3
Chemical Oxygen Demand
Fecal Coliform Total Suspended Solids
Benchmarks =
120 mg/L
1000 count per 100 mL 100 mg/L or 50 mg/L4
fAla:s4
fe,•
ZIvo,S
le .15"
S L r
' Monthly sampling (instead of semi-annual) must begin eA.!ith 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.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies:
Note: Results must be reportedin 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. 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
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Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
Date,Sample
Outfall No.
Collected
-lmo/dd/Yr)
Benchmarks =__>
Footnotes from Part A also apply to this Part B
U No discharge this period:
24-hour rainfall
amount, ' Non polar O&G/TPH by
Inches3 EPA 1664 (SGT -HEM) Totaf Suspended Solids. pH
i5 mg/L 100 mg/Lor 50 mg/C4 6.0 - 9.6:5lI
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 11 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.
s 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 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 forgathering 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)
it Date: 11/1/2012-10/31/2017 SWU-248, last revised 10/25/2012
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