NCG120013 DMR SW (13)

Se,i—annual Stormwater Discharge I on toring Report
¢(.,r North Carolina Divisii n ;.4 Water Quality General Permit No. NCG120000
Date submitted -10 i5( kW
CERTIFICATE OF COVERAGE NO.l3".�•eG22 .'�
SAMPLE COLLECTION YEAR U,"
I. a.' 1 �... ! .../: t, t? , '., r:, SAMPLE PERIOD ❑ n-June III July-Dec
FACILITY NAME
or Monthly'' Iii.sA1, (month)
COUNTY (. U iI-(i)crii. DISCHARGING TO CLASS ❑ORW ❑HQw ❑Trout ❑P;NA
PERSON COLLECTING SAMPLES �,11� J�inv�5ov� ❑Zero-flow ®�I/ater Supply OSA
LABORATORY �OX1t0(,�n Lab Cert.# 1td�s CEI�
Comments on sample collection or analysis: - REVED
WO C ScAf lIkrof l p—ri ° rali n� \I\ JUL 8 'U W PLEASE REMEMBER TO SIGN ON THE REVERSE
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CENTFZQL FIDS
Part A:Stormwater Benchmarks and Monitoring Results DWR SECTIO'
I No discharge this period?2 �
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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 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,;BDL,<PQL, Non-detect, ND,or other similar non-
numerical format. When results are-below_the applicable limits;th'ev must be reported in•the format;,"<XX-ms /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: 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.
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 AAND PART B MONITORING RESULTS:
0 A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
m 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 EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑NO
Nr
IF YES,HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES 0 NO❑ _
REGIONAL OFFICE CONTACT NAME: .. . '_-
Mail an original and one'co ilr of this DMR,including all"No Discharge"reports, within 30 days of receipt of thelab results for 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 directly responsible for gathering the information,the information submitted is,to the best of my ynowledge 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."
(°-5Ati 11
(Signature of r i tee) (Date) -
Permit Date:11/1/2012-10/31/2017
SWU-248,last revised 10/25/2012
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