NCG120013 DMR SW (5)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Qual-ty G neral Permit No. NCG120000
Date submitted -6) / 4
CERTIFICATE OF COVERAGE NO. NCG12
FACILITY NAME
COUNTY t1�
PERSON COLLECTING SAMPLES f-6- f-4in
LABORATORY I"lp rl' i -beu Lab Cert. #
Comments gn sample collegction or analysis:,,.
NG �ISC�I�r�t' Olvi i C -� "!K 6ur5
Part A: Stormvuater Benchmarks and Monitoring Results
SAMPLE COLLECTI
YEAR
SAMPLE PERIOD. U.Jan-
REC �,/ or �oi
�15ING TO CLASS
MAR 0 7 -/b;
CE�►s
REZE
MAR 0 7 2016
CENTRAL FILES
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PLEASE REMEMBER TO SIGN ON THE REVERSE 4
h2lNo discharge this.period?2
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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.
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 examiile:jdo not report:_Below.Detection Limit, BDL, <PQL, Noii=detect, ND, or;other similar non -
numerical format.. When results are�below:the::applicAle .limits,:thev must be:.re'ported in the.format ="<XX`ms/L" where XX,;is.the.numerical value oflthe
detection limit, reportinglimit, etc. in mg/L ,Co.nversely, where'fecal:coliform results exceed the dilution upper limit, report`the: result as'5XX'°.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier'! responses. See General Permit text.
Permit Date: 11/1/2012-10/31/2017 SWU-248, last revised 10/2-5/2012
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Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
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Footnotes from Part A also apply to this Part B
(Vote: 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:
0 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 TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
0 TIER!: HAS -'YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC V FOR THE -SAME PARAMETER�AT ANY; ONE OUTFALL? YES ❑ NO Q
IF YES, HAVE YOU CONTACTED� H_E� DWQ GIONAL OFFICE?.:. YES VNO Q
REGIONAL OFFICE CONTACT•NAMt:- lis Z . Gt5n e.,r
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Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North. Carolina .27699-1617
YOU MUST SIGN THIS:CERTIFICATIONTOR '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.pr'operly gather and evaluate the information submitted. B'as'ed 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_knowl6dge.and belief, true, -accurate, and complete.
am aware that there are signif*cant penal " r submitting false information; including the possibility of fines and..imprisonment for knowing violations."
(Signp#ure of Permittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-248, last revised 10/25/2012
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