NCG120013 DMR SW (9)

Sema -annual Starmwater Discharge Monitoring ReRo rt
for North Carolina Division of Water QUII$y/General Permit No. NCG120000
Date submitted / '1 ry t
CERTIFICATE OF COVERAGtNO. NCG12Q 0 `` �' 3 . } f SAMPLE COLLECTION YEAR 2 -DI -5
FACILITY NAME ��Ir, r✓b'eCt �u�l�l�iC� M!(-favi=r�slr�� SAMPLE PERIOD ❑ J n -June ❑ July -Dec
c®uNTv (
or Monthly' �uP.s►'1�7u- (month)
aur l� °-
PERSON COLLECTING SAMPLES Gy z. NI`L4 D SCHARGING TO ,CLASS ❑ORW ❑HQW/❑Trout ❑P;NA
LABORATORY N%z�f i c%� Lab Cert. # � 1,� �'EC;
ENO ❑Zero -flow [Water Supply EISA
Comments on sample collection or analysis:❑Other
JAIL 1 ,9 2016
Part A: Stormwater Benchmarks and Monitoring Results
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE �
DWR SECTION
n No discharge this period?Z
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'-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.
3 The 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 example. -do not report Below.Detection Limit,; B,DL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are -below -the applicable limits,'thev must be reported in the format.'"<XXmg/L".•wh'e're 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 tent.
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.
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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:
® A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
ra 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
o TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ®fN0 ❑
IF YES, HAVE YOU CONTACTED THE WQ REGIO AL OFFICE? YES NO ❑ _
REGIONAL OFFICE CONTACT NAME: CLS-wicheX
Mail an original and one copy of this DMR, includina all "lilo Disc ivrae" reports, within 30 dais of receipt of the lab results -(or at end of monitorina 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 a ,thW a�ign!Ay ant petaa"dr submitting false information; including the possibility of fines and imprisonment for knowing violations."
(Signature of
Permit Date: 11/1/2012-10/31/2017
8401(
(D to
SWU-248, last revised 10/25/2012
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