NCG120042 DMR SW (4)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG120000
Date submitted re b 1'1 , Z0 Ica
CERTIFICATE OF COVERAGE NON 12-g "` i--
FACILITY NAME lZA
COUNTY_-.-, ck
PERSON COLLECTING SAMPLES
LABORATORY Anc_U (,+-ca\ Lab Cert. # LF `+ 0
Comments on sample collection or analysis:
GmllecfesQ cl�.rl..S c_e__p,A cLo—&-ocut.- _ ov,Q"
� gPero7� \ b..- l S ��'^` SCS . OvGr w 1na.�MtcX 5�S'iewS
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2 D c (o
SMP aP $ OD ❑ Jan -June [:]Jul Dec
uI�Lronthly' !✓�br�a,. month
Dl f yfflG TO CLASS ❑ORW ❑HQW Trout ❑PNA
«� Z016 []Zero -flow ❑Water supply [:]SA
CE'VTRAL piL .. 00ther L1Q 5 5 C_
ON
PLEASE REMEMBER TO SIGN ON THE REVERSE 3
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Chemical Oxygen Demand
IJ IVU uraWtUl yc Llllb /JCIIUUr
Fecal Coliform Total Suspended Solids
Benchmarks =__>
_
-
120 mg/L
1000 count per 100 mL 100 mg/L or 50 mg/L°
,5 0c)
SDS
a 3
1 IL
t-4 L�
17-r13 ns L4
5
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
n-
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 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
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period?2
Date Sample
24-hour rainfall
Outfall No.
Collected'
amount,
Non -polar O&G/TPH by
Total Suspended Solids
pH
(mo/dd/yr)
Inches3
EPA 1664 (SGT -HEM)
Benchmarks =__> -
-
15 mg/L
100 mg/L or 50 mg/L°
6.0 — 9.0 SU
Rp
(,2-5
5�
3 • 5
C9-9 3.
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.
a 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER-ATTHE SAME OUTFALLTRIGGER 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 ANYONE OUTFALL? YES ❑ NO E.
IF YES, HAVE YOU CONTACTED THE DWQ 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 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
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date: 11/1/2012-10/31/2017
Fe.b l a 120«
(Date)
SWU-248, last revised 10/25/2012
Page 2 of 2