NCG210412 DMR SW (4)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 8"%6 -/r
CERTIFICATE OF COVERAGE NO. I� - 71'5V° ' SAMPLE COLLECTION YEAR 204
FACILITY NAME 1371.5t,I ndttb��ri65 , jnG. SAMPLE PERIOD ❑Jan-Junes [i iuly-Dec
COUNTY �Jufrf� or ❑Monthly (month)
PERSON COLLECTING .A PLES 6 &rnha pry DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORYL1kter tech Labs Lab Cert.# RECEIVED- ❑Zero-flow ❑Water Supply DSA
Comments on sample collection or analysis: [Other U..5.—/V
AUG 17
LEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FIL
Part A:Stormwater Benchmarks and Monitoring Results (Monitoring is required or Jl ehgacilt9stores exposed accumulations of sawdust,wood chips,
bark,mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period?2
Date Sample 24-hour rainfall
Outfall No. Collected) amount,
(mo/dd/yr) Inches3 Chemical Oxygen Demand Total Suspended Solids
Benchmarks===> - - 120 mg/L 100 mg/L or 50 mg/L4 •
$ 4/i6 3/S " < aO n,Q�/�. 2 7•U.•riJ/L-
•
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,they 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.
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:8/1/2013-7/31/2018 - SWU-245,last revised 7/31/2013
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Part B: Vehicle Maintenance Area Monitoring Results:only for facilities averaging>55 gal of new oil per month.
❑No discharge this period?2
Date Sample 24-hour rainfall
Outfall No. Collected) amount,
Non-polar O&G by EPA
1664(SGT-HEM) Total Suspended Solids
N A (mo/dd/yr) Inches
Benchmarks===> _ - 15 mg/L 100 mg/L or 50 mg/L4
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:
• 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.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY1�
ONE OUTFALL? YES ❑NO
IF YES,HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑NO❑
REGIONAL OFFICE CONTACT NAME:
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 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 ••ualified personnel pro,•erly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system,or
those per-•,ns dire ly re, sib). '•r gathering the-i• + _•n,the informs submitted is,to the best of my knowledge and belief,true,accurate,and complete. I
am a hat th ifi�. penaltie. e•. : "ation,including the possibility of fines and imprisonment for knowing violations."
a4
(Signature of-rmittee) �`� (Date) Vi
Permit Date:8/1/2013-7/31/2018 - SWU-245,last revised 7/31/2013
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