NCG120060 DMR SW (2)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG120000
Date submitted
CERTIFICATE OF CO ERAGE NO. IVCG12
r Q
FACILITY NAME �o
COUNTY q
PERSON COLLECTIN SAMPLES a �p��s'
n
LABORATORY CSC@, Lab Cert. #
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
RECEIVED
JAN 08 ZUi6
CENTRAL FILES
®WP -,-=N
SAMPLE COLLECTION YEAR a� D 15'
SAMPLE PERIOD Fj Jan -June L?uly-Dec
or ❑ Monthly' fmonthl
DISCHARGING TO CLASS r_jORW []HQW []Trout []PNA
❑Zero -flow []Water Supply []SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Outfall No.
Date Sample 24-hour rainfall
Collected' amount,
(mo/dd/yr) Inches' Chemical Oxygen Demand
No dl:
Fecal Coliform
Benchmarks ===>
_ - 120 mg/L
1000 count per 100 mL
.38
Al v
this
Total Suspended Solids
100 mg/L or 50 mg/V
t,3
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 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 maybe eligible for a waiver of the rain gauge requirement.
`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, 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: !f 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
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
Footnotes fr
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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.
• 2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cony of this DMR includina 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 directl esponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am,*arethatther ar signific t penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Si t e
ature of Perm ) D — /6
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-248, last revised 10/25/2012
Page 2 of 2
tJ ivu uiscnarge
rn►s period r -
Outfall No. Date Sample 24-hour rainfall
Collected' amount, Non -polar O&G/TPH by
(mo/dd/yr) Inches3 EPA 1664 SGT -HEM)
Total Suspended Solids
pH
Benchmarks ===> _ - 15 mg/L
100 mg/L or 50 mg/LQ
6.0 — 9.0 SU
3.7
!im Part 0 alcn annhi to this o .4 n
,-., ­ ....v . ... a ..
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.
• 2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cony of this DMR includina 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 directl esponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am,*arethatther ar signific t penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Si t e
ature of Perm ) D — /6
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-248, last revised 10/25/2012
Page 2 of 2