NCG200477 DMR SW

Semi-annual aormwater Discharge Monitoring Report (DMR
for North Carolina DRALRGeneral Permit No NCG200000-crap Metal Rec(ding
Date submitted
CERTIRGATEOFOOVERAGENO NC MO_O, �
FAaUTYNAME r` 2 f,J S•
OOUNTY
PERSON ODLLECTINGSWPLES
LABORATORY Lab Cart #
Comments on sample collection or analysis
Part A Rormwater Benchmarks and Monitoring Results
S4M PLE ODU_ECTI ON YEAR
SWPLEPERIOD ❑ ,an -June ® July -Dec
or ❑ Monthly' (month)
D193ifRGINGTOCLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑S4-
❑Saltwater Other Cl -ASS C
PLEASE FEM EM BERTO SIGN ON THE F ❑
IV 4'.tti.,-.harnathicnpnnrl?2
Outfall No Date Semple 24-hour rainfall
Collected amount, Total Sispended
(mo/dd/yr) Inches' Solids
Non -polar oil & grease
Chemical Oxygen EPA Method 1664
Demand (S3T-HBVI)
Copper,
Total
Lead,
Total
Zinc,
Total
Benchmarks==> _ 100mgtLor
50 mg/ L°
120 mg/ L 15 mg/ L
0010mg/Lor
0 005 mg/ L5
0075mg/Lor
0 210 mg/ L5
0126mg/ Lor
0 090 mg/ L5
ivionimy sampling (insteaa OT semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall
2For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here
'The total precipitation must be recorded using data from an on-site rain gauge Unattended sites maybe eligible for a waiver of the rain gauge requirement
° See General Permit text, Table 3 or Table 4, identifying protected receiving water classifications where the more protective TSS benchmark applies
e Stormwater discharges into receiving waters classified as saltwater are subject to the second listed benchmark
Note Fbsults must be reported in 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, Lay muube reporCe❑in Ila formate' <M mg/ L', where Misthe numerical value of the
detection limit, reporting limit, quantitation 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 Sae General Permit
Permit Date 02/02/2015-12/31/2019
R E' IV
JAN I�9 2016
CENTRAL FILES
DWR SECTION
SM -256, last revised 1/28/2015
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Part B Vehicle Maintenance Area Monitoring Results only for facil it iesaveraging>55 gal of new oil per month
I-1 No dlscharae this Denod?2
Date,%mple
Outfall No Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches?
Non -polar O&G by EPA
1664 (S3T-HEM) Total Suspended lids
Benchmarks=> _
15 mg/ L 100 mg/ Lor 50 mgr L
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
FOR PARTAAND PART B MONITORNG FESI1LTS
❑ ASNGLEBBdCHMARKB(CBE3DANCETRGGERSTIERI RMUIR MENTS
❑ 2IXCIANCESINAROW FORTHESWEPARAMErERATTHESWEOUTFALLTRGGB2119R2RBQUIRBVIBdTS
❑ TIER3 HASYOURFAOUTYHAD 4ORMOREBENCHMARKIXCEEDANCESFORTHESWEPARAMEERATANYONEOUTFALL? YE5❑NO❑
IFYE5 HAVE YOU CONTACTED THE DBA URFE3ONALOFF! CEASFF_QUIFED BYTHEFEW IT? YE5 ❑ NO❑
REGONAL OFFICE CONTACT NAME
Mail an original and one conv of this DMR indullno all "No Discharge' reports. within 30 days of reoeiot of the lab results (or at end of monitonna oenod
in the case of "No Discharge" reports) to
Division of Water Fbsources
Attn DWRCentral Files
1617 Mail Syrwce Center
Faleigh, North Carolina 27699-1617
YOU MUSrSGN THISCBUF1CAl1ON FORANYINFOFMATION REPORTED
"I oertify, under penalty of lav, that thisdocument and all attachmentswere prepared under my direction or supervision in aanrdancewith 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 penaltiesfor submitting false information, including the possibility of fines and imprisonment for knowing violations"
"�� tv /Z 1�1- /I
(Signature of Permittee) (Date)
Permit Date 02/02/2015-12/31/2019 SNU-256, last revised 1/28/2015
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