NCG120013 DMR SW (15)

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Sem -annual Stsrilmesater Ilscharge [ 'onitie)ring f ei ort
for North Carolina Division of , 'ater Quality General Permit No. NCG1Z0000
Date submitted (2)''J/2-411(.0
I��g4 _ ` 70:77.!: -; . SAMPLE COLLECTION YEAR 2v1 to
CERTIFICATE OF COVERAGE NO.
FACILITY NAME Wk 'k, SI reel-- La incPC,)( (6 i y a' Green5,6j SAMPLE PERIOD ❑Jan-June ❑July-Dec ,
COUNTY Gu;1 c:.,rJ or Q Monthly' A r 1 I (month)
PERSON COLLECTING SAMPLES ;clvar� 1n 1 ove�} _ DISCHARGING TO CLASS OORW OHQW OTrout OPI,NA
LABORATORY 1-14r 4-eLh , TAC. Lab Cert.# )6,5- � ��/ ® ❑Zero-flow awater Supply OSA
Comments on sample collection or analysis: MAY 3 1 2016 ❑other _
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE
DWR SECTION
Part A:Stormwater Benchmarks and Monitoring.Results
. n No discharge this period?2 1
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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,'thev 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: 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 A AND PART B MONITORING RESULTS:
® A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
m 2 EXCEEDANCES INA 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 0 NO❑
IF YES,HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES NO❑ _
REGIONAL OFFICE CONTACT NAME: Ca I%T6c�. awl - _
Mail an original and one'copy of this DMI?,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 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 penaltie /44.-s fm* mg f s ' rmation,including the possibility of fines andd-imprisonment for knowing violations."
F /
->7ZY7/6
(Signature of Permittee) (Date)
Permit Date:11/1/2012-10/31/2017 SWU-248,last revised 10/25/2012
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