NCG070006 DMR SW (3)

North Carolina Division of Energy, Mineral, and Land Resources
SEMI-ANNUAL STORMWATER OUTFALL DISCHARGE MONITORING REPORT (DMR)
Vehicle Maintenance Activities Only
Date submitted 7/12/AD,d
CERTIFICATE OF COVERAGE NO. NCFG SAMPLE COLLECTION YEAR ,2®16
FACILITY NAME A-4 v14,004.4 ✓ &pry
COUNTY ST4i1.442:
PERSON COLLECTING SAMPLES PLEASE REMEMBER TO SIGN ON THE REVERSE-3
LABORATORY Lab Cert.#
Vehicle Maintenance Activity(VMA)Stormwater Monitoring Results: Only for facilities using an average of>55 gal of new Vim orfO oilAirr on"th.
Total event rainfall 1 or ❑ No discharge this period' JUL 1 5 2016
Outfall No. Sample Total Suspended Non-polar O&G/TPH,mg/L Oil and Grease,mg/L pH,Standard units riMNe
iyojoQi,E0sige,
- Collected, Solids(TSS),mg/L (Method 1664 SGT-HEM) (if applicable) (if applicable) INF( average
gal/mo
mm/dd/yr (if applicable)
Benchmark - 100 or 503 15 30 Within 6.0—9:0 -
A/D 191SCH41[1.,1 Mot SAA% —SV .y RD if.
1 The total precipitation must be recorded using data from an on-site rain gauge.
2 For sampling periods with no discharge at any outfalls.You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text that identifies the especially sensitive receiving water classifications where the more protective TSS benchmark applies.
Note: Results must be reported in numerical format. For example,do not report Below Detection Limit, BDL, <PQL, Non-detect, ND,or any other similar non-
numerical format. When results are below the applicable limits,they must be reported in the format, "<XX mg/L",where XX is the numerical value of the
laboratory's detection limit, reporting 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. See General Permit text.
FOR MONITORING RESULTS:
• -A single benchmark exceedance triggers TIER 1 REQUIREMENTS. See permit PART II SECTION B or C.
• Two exceedances in a row for the same parameter at the same outfall trigger TIER 2 REQUIREMENTS.
• TIER 3: Has your facility had four or more benchmark exceedances for the same parameter at any one outfall? YES ❑ NO ❑
IF YES: Have you contacted the DEMLR Regional Office? YES ❑ NO❑
REGIONAL OFFICE CONTACT NAME:
SWU-254 Vehicle Maintenance Activities DMR Last Revised:August 11, 2014
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Mail an original and one copy of this DMR, including 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 Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 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 that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
7f12-f16 -
(Sign re of Permittee) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/Ir/npdes-stormwater
SWU-254 Vehicle Maintenance Activities DMR Last Revised:August 11, 2014
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