NCG030091 DMR SW (6)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
r 'fit% -15
* 0
CERTIFICATE OF COVERAGE N050'G-02
SAMPLE COLLECTION YEAR
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec f
FACILITY NAME i cA�� ��� �C �'� �b �Ja�ti
or amonthlyl -,Q month
COUNTY C (a.«\ c.N �A
DISCHARGING TO CLASS ❑ORW OH Q ]Trout ❑PNA
PERSON CbLLECTING SAMPLES SIJ
[]WaterSupply []SA
LABORATORY ff SSS d-� Lab Cert. # n�
�a [Other
RECEIVED
Comments on sample collection or analysis:
e'Y�
MAR 2015 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3
CENTRAL R,AL FILES
Part A: Stormwater Benchmarks and Monitoring Results
DWR SECTION No discharge this period?Z
Non -Polar 0&G/ Total Toxic
Date,Sampl"e ' 24-hour rainfallTotal Suspended Solids
Outfall No, i
PH, Copper Lead Zinc Total Petroleum s
HydrocarOrganics Standard units bons
Collected amount,
1
(mo%dd/yr,) ' Inches3
- 100 mg/L or 50 mg/L
6.0'— 9.0 0.007 mg/L 0.033 mg/L 0.067 mg/L 15 mg/L 1 mg/L
Benchmarks =__> -
GRL_�-
0t - J�h_ �r� �s �tai,�L�
G
f. ._J_ I U. �3 y
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark
discharge
exce or ng report with a nce Tor the same arametelr at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this
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, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform
the definitiolng n of Total (Toxic OrganicsUs that definitionre oconta contained manufacture
ntthe EPA
electronic crystals, or manufacture cathode ray tubes. For purposes of this permitin 40 CFR 433,11; for
Effluent Guidelines for the Facility subject to the requirement to sample (for metal
manufacture
use the use the definlon as founition as fours d in 40 FR 469 22 and for�athoderray
manufacture use the definition as Found in 40 CFR 469.12; for electronic crystal
tube manufacture use the definition found in 40 CFR 469.31).
permit -Dr 1,1/1/2012-10/3;1:/201-7, ,
S,WO.2,4, 5; Jast revised 10/25/2Q12
Page 1 of 3

Facilitic, incorporate a solvent management plan into the Stormwater. , pion Prevention Plan may so certify, and the requirement for TT(, ,-„�,nitoring
may be waived. The solvent management plan shall include a list of the totaltoxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan.”
Name (Print name)
Title (Print title)
(Signature)
(Date)
Note: Results must be reported in numerical format. 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 mg/L", where )0( is the numerical value of the detection
Ili -nit, reporting limit, etc. in mg/L,
iQ4oter QV 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.
Dart R: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
y
Outfall -No.
Benchmarks =-_> •
Date.Sample' '`24=h'our
Cullected�
(mo/.dd/yr)
rainfall
amounts
Inches',.
-
;fUon-polar©TSG/Tpl9 by
EnA,1664(SG1'-MEM)
15,mg/L,
t- ,VU Urscriurge
TotalSuspended;Solids
100•mg/L,or 50•mg/,A:4`,
rnis periodr-
pM,
6.0- 9.0°SU'
footnotes frorxr Part A also apply to this Part 0
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit D,Ao: 11/9./2012-10/31/2017 `
SWU-245, last revised 10/25/2012
Page 2 of 3

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.13 MONITORING RESULTS;
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
e TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES NO ❑
Ir, YES, HAVE YOU CONTACTED THE DWQ REGIO AL OFFICE YES ETN O ❑
REGIONAL OFFICE CONTACT NAME: >1
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 REPORTS®:
"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
on my
ry of the person or persons who
the system, or
assure that qualified personnel properly gather and evaluate the
informatthe inforlon submitted. Basemation submitted is, o the best olf my knowledge and belief, true, accurate, and complete. I
those persons directly responsible for gathering the information,
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Perm
V -U. -1s
(Date)
SW,U-245, last revised in(25/2012
Permit D,-' , 1-1/1/2012-10%31/2017 Page 3 of 3