NCG120013 DMR SW (6)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG120000
Date submitted 12�
CERTIFICATE�OF CsVERAGE NO. NCG12 ® D I SAMPLE COLLECTION YEAR.
FACILITY NAI1nE �iM�C �✓�-.i�e-lr�( 1+�! �! SAMPLE PERIOD. Q.Jan-June [:] July -Dec
oronthly1(month
COUNTY Qik'f Io
PERSON COLLECta'-dLi DISCHARGING TO CLASS ❑ORW . ❑HQ ❑Trout ❑P;NA
sI NG SAMPLES U �- "_
LABORATORY Lab Cert. # REC
IV ❑Zero -flow �41ater Supply ❑SA
Comments on sample collection or analysis: [:]Other
Part A: Stormwater Benchmarks and Monitoring Results
FEB 0 3 2016
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES
DWR SECTION
n.No discharge this.period?2
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®04 01 is I& IP qcq
1 Monthly sampling, (instead of semi-annual).must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'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 imnumerical format:- for exaniple;-do not report:Below-Detection Limit,'
imit ;.B,DL,.<PQL, Non=detect, ND, or.other similar non -
numerical format. . When results are below:the;:applicable.limiis,aliev must be:eeportetl in the:format:`.'<XX me/L" where XX isahe numerical value ofthe
detection limit, reporting limit, etc. in mg/L.. Conversely, where'fecal:coliform results exceed the dilution upper limit, report.theresult 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 IVlaintenance 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
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:
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.
a TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC .S FORTH E. SAME PARAMETER AT ANY; ONE OUTFALL? YES ❑ NO Q
IF YES, HAVE YOU 1CONTACTED THE DWQ REGIONAL OFFICE?: . YES NO Q -
REGIONAL OFFICE CONTACT.NAME:It nclety
Division of Water Quality
Attn: DWQ'Central Files
1617 Mail Service Center
Raleigh, North. Carolina. 27699-161.7
"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.knowl'edge.and belief, true, accurate, and complete.
am aware, r t thge op sign i a alties for submitting false information; including the possibility of fines and._ imprisonment for knowing violations."
of
Permit Date:
( ate)
017 SWU-248, last revised 10/25/2012
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