NCG080196_MONITORING INFO_20190110

PERMIT NO.
DOC TYPE
DOC DATE
STORMWATER DIVISION CODING SHEET
NCG PERMITS
/V �v8"D
F] HISTORICAL FILE
[MONITORING REPORTS
o aoigo„o
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calinnrlar Year 2n18
P1Zf-'ACIt rr—r--.
Certificate of Coverage (COC) No NCGO80196
_ ZOi9
This monitoring report summary of the calendar year should be kept on file on site with the facility SPPP JAN 10
�,�;
Facility Name United Parcel Service -Winston Salem CENTRAL r=iCWR CECT16111
County Forsyth
Phone Number 919 790 7474 Total no of SDOs monitored 2
Outfall No SDO-001
Is this outfall currently in Tier 2 (monitored monthly)?
Yes
No
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
Yes ❑
No FRI
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency
❑
Received approval from DWQto reduce monitoring frequency
0
Other
El
Was this SDO monitored because of vehicle maintenance activities?
Yes 1X
No
Total
Rainfall,
inches
Parameters, (units)
Total Suspended Solids
(mg/L)
PH (Standard Units)
Non Polar Oil and Grease/TPH EPA
Method 1664 (SGT HEM) (mg/L)
Benchmark
N/A
50 or 100 see permit
Within 6 0 — 9 0
is
Date Sample
Collected
03/11/2018
7023
178
804
<50
09/26/2018
55
858
< 5 0
Outfall No SDO-002
Is this outfall currently in Tier 2 (monitored monthly)?
Yes ❑
No 0
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
Yes
No =
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency
Received approval from DWQ to reduce monitoring frequency
El
Other
Was this SDO monitored because of vehicle maintenance activities?
Yes 1XI
No
Total
Rainfall
Inches
Parameters, (units)
Total Suspended Solids
(mg/L)
pH {Standard Units)
Non Polar Oil and Grease/TPH EPA
Method 1664 (SGT HEM) (mg/f.)
Benchmark
N/A
50 or 100 see permit
Within 5 0 — 9 0
15
Date Sample
Collected
03/12/2019
023
325
781
< 5 0
09/26/2018
019
1020
776
c 5 0
"1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a
system &Signed to assure that qualihcd personnel properly gather and evaluate the information submitted Based on my mquir� of the person
or persons who manage the system or those persons directi) 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 penalttcs for submitting false information
including the possibility of fines and imprisonment for knowing violations
Signature
Date
For questions, contact your local Regional Office
United Parcel 5ervice Winston Salem SWU 264 Generic Annual DMR
Last revised 5/17/2013

Outfall No
Is this outfall currently in Tier 2 (monitored monthly)?
Yes
No
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
Yes
No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency
❑
Received approval from DWQ to reduce monitoring frequency
Other
❑
Was this SDO monitored because of vehicle maintenance activities?
Yes
No
Total
Rainfall,
inches
Parameters, (units)
Total Suspended Solids
{mg/t)
pH (Standard Units)
Non Polar Oil and Grease/TPH EPA
Method 1664 (SGT HEM) (mg/L)
Benchmark
N/A
50 or 100 see permit
Within 6 0 — 9 0
15
Date Sample
Collected
Outfall No
Is this outfall currently in Tier 2 (monitored monthly)? Yes No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes No
If this outfall was in Tier 2 last year, wiry was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes No
Total
Rainfall,
Inches
Parameters, (units)
Total Suspended Solids
(mg/L)
pH (standard Units)
Non Polar Oil and Grease/TPH EPA
Method 1664 (SGT HEM), (mg/L)
Benchmark
N/A
50 or 100 see permit
Within 6 0— 9 0
15
Date Sample
Collected
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 persom who manage the system or those persons direct]} responsible for gathering the information the information submitted is to the
best of my knowledge and belief true accurate and complete 1 am aware that there are significant penalties for submitting false information
including the possibility of mes and imprisonment for knowing violations q
Signature / v4 Date
For questions, contact your local Regional Office
United Parcel Service Winston Salem SWU 264 Generic Annual DMR
Last revised 5/17/2013

l
August 22, 2018
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699 - 1617
RECEIVED
AUG 2 8 2018
CENT NAL RLES
DWR SI~CTION
Re Stormwater Discharge Outfall Monitoring Report (DMR) Year 6, Period 1, Sample 11 - 2018
United Parcel Service — Winston Salem
199 Park Plaza Drive, Winston Salem, North Carolina (Forsyth County)
General Permit NCG080000, Certificate of Coverage No NCG080196
Dear Stormwater Permitting Unit,
We respectfully submit the enclosed original and one copy of the Stormwater Discharge Outfall
Monitoring Report for the United Parcel Service — Winston Salem under General Permit Number
NCG080000, Certificate of Coverage No NCGO80196 This submission is for Stormwater discharge
sampling during Year 6, Period 1, Sample Number I l (January — June, 2018) as outlined in Part II,
Section B of our storms eater discharge permit We are happy to report that all sample analytical results
were below benchmark values and/or within the benchmark ranges
If you have any questions or comments regarding this Stormwater Discharge Outfall Monitoring
Report (DMR), please contact us at your convenience
Sincerely,
d
J
Vincent Mollo
District Environmental Coordinator
United Parcel Service, Inc
Enclosures Stormwater Discharge Outfall Monitoring Report (DMR), 1 original & I copy

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCGO80000
Date submitted 07/08/2018
CERTIFICATE OF COVERAGE NO NCGO80196
FACILITY NAME United Parcel Service Winston-Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO INC )
LABORATORY Pace Analytical Services, Inc Lab Cert # 12, 40, 37706, & 37712
LABORATORY INENCO, Inc Lab Cert # 5540
Comments on sample collection or analysis
SAMPLE COLLECTION YEAR 2018
SAMPLE PERIOD �lan-June El July -Dec
or Monthly' (month)
DISCHARGING TO CLASS [::]ORW F—]HQW Trout E]PNA
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitoring Requirements (If applicable)
Zero -flow Water Supply EISA
FX Other Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
X yes no
No discharge this period 2 z
6-? Outfall
V No f�� nt
n
HG {
'` Date �' ° ^i
i 4 rAD. 2A 'y"3� t�S
; sample Collected; ,-4
`F r Z' E ,'
Imo/dd/yr '
�% zd;r,Nr`x Zti0530��;�f;�
I ei`� £�;,00400- T,o ra-
h°+' `� rqE,{00556
�ELi%ay'x °t 1 th ,si
Total Sdspendedll �,
-A x� t \ -i
M Solids; mg/I `,�,
, Y!`�s2 pH; . r z+t
s`.t
; 3N,, Standard units S n
Fv' x Non -Polar Oil and Gredse/TPH EPA
�. , w 4 �£ . �'`
Method 1664 (SGT-HEM), mg/1 y
�t� ,` "New Motor Oil Usage,
.c tr, t�... ti
1= }Annual average gal/mo
Benchmark ,
? < ' F -'s , Y`
i 50 or 100'see pe6nitu
--,Within 60=90..s
Y„ t ��,e 3"1'15 �r. ,..,
1"'
SDO-001
03/11/2018
178
804
< 5 0
153
SDO-002
03/11/2018
325
781
< 5 0
153
PartB Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
'47y'Outfap 4
~ti ti };f
,1,No
4k ��}
T a'1 : `,� r
A.
Date
h f i e
V7^ h�.i�` k"
j Sample Collected, ,
�yEl_ "n `y 1i♦i �t �
4 'di a'1h °[.
it" i
_. mo/dd/yrh
Y s I . w +�i i 00556 4" t `'
4 Y� ^ fi ,ra'x 4
00530 -
`t�� r t- ti 5T �..� �st+t
f4 4 \«sh�00400ti r _,
t�.+V' y 111
zix�4�^ Non -Polar Oil and Grease/TPH EPA Method,tr >s
}KL 4 l'1 Zfi'S14Y 44 1 kf7 +Q iao al h.I 1[ i 1 '+ q, 4
p,�i>`F has r 4wti€ tr F r �� J z L' \
\i Z 4 �1 .tv
-- 4 ,� 1664 (SGT-HEM), mg/L a, , , w
! �Y •i w4 l e r �
. a Total Suspended Solids s
y,f Rf ���1; .,lit C1F a 1 4 ti4 `r.i
T�s. 'Z-4 '' f`, '� it
1 i�S'1 5 fa°tiv \CL'L��u�'t ..rik 4 `
s, t ,_ ,mg/I y t 5 nun , ;
S r 1a }t j H- tV v} <! �.
r �' pH �+
�i 11t�. \yl } /t i �, 4a ar f:
+, �Ss� l
�t \ S:`2 q 'hef-.�� 2t
4A, Standard units Z r
i Permit Lima'
e i I
' S0 or`100 see perrinrt�` �� ,
t
Y Withm`6 0 - 9'�0
1
I For sam�ling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here
SWU 250 last revised April 11 2013
11 Page 1 of 2

United Parcel Service Winston Salem
STORM EVENT CHARACTERISTICS
Date 03/11/2018 (first event sampled)
Total Event Precipitation (inches) 023
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (Inches)
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 8
• 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 ANYONE OUTFALL? YES F NO 0
IF YES HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F] NO
REGIONAL OFFICE CONTACT NAME
Mail an original and one copy of this DMR, including all "Na Discharge" rep
orts,within 30 days of receipt of the lob results or at end of monitor ngperiod 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 penalties for submitting false information including the possibility of fines and imprisonment for knowing violations
Additional copies of this form may be downloaded at
_Z 4 l8
(Datel
htt ortal ncdenr or web w ws su n dessw#itab-4
40
SWU 250
last revised April 11 2013
Page 2 of 2

r'
.January 8, 2018
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699 - 1617
JAB � 0 2�58
1Nf�RMA�Ott 4R4C
Re Stormwater Discharge Outfall Monitoring Report (DMR) Year 5, Period 2, Sample 10 - 2017
United Parcel Service — Winston Salem
199 Park Plaza Drive Winston Salem North Carolina (Forsyth County)
General Permit NCG080000, Certificate of Coverage No NCG080196
Dear Stormwater Permitting Unit,
We respectfully submit the enclosed original and one copy of the Stormwater Discharge Outfall
Monitoring Report for the United Parcel Service — Winston Salem under General Permit Number
NCGO80000, Certificate of Coverage No NCG080196 This submission is for stormwater discharge
sampling during Year 5, Period 2, Sample Number 10 (July to December, 2017) as outlined in Part 11
Section B of our stormwater discharge permit We are happy to report that all sample analytical results
were below benchmark values and/or within the benchmark ranges
If you have any questions or comments regarding this Stormwater Discharge Outfall Monitoring
Report (I)MR), please contact us at your convenience
Sincerely,
4VOO--'-
Vincent Mollo
District Environmental Coordinator
United Parcel Service Inc
Enclosures Stormwater Discharge Outfall Monitoring Report (DMR), I original & l copy

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCG080000
Date submitted 11/15/2017
CERTIFICATE Of COVERAGE NO NCGO80196 SAMPLE COLLECTION YEAR 2017
FACILITY NAME United_ Parcel Service Winston Salem SAMPLE PERIOD ❑Jan June Lil July Dec
COUNTY Forsyth or [DManthly' (month)
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO INC )
LABORATORY Pace Analytical Services Inc Lab Cent # 40 37712 & 442
LABORATORY INENCO Inc Lab Cert # 5540
Comments on sample collection or anahrsis
DISCHARGING TO CLASS ❑ORW []HQW Trout F_�PNA
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitoring Requirements (if applicable)
Zero flow ❑ Water Supply FISA
Mother Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
X yes no
❑ No discharge this period?
outfall
No,
Date
Sample Collected,
mo/dd/yr
00530
D0400
+ 00556
r .j 1
Total Suspended
Solids, mg/I
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
SO or 100 we permit
Within 6 o — 9 0
15
-
S00 001
09/11/2017
169
870
c 5 0
159
SDO 002
09/11/2017
117
813
< 5 0
159
PartS Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
Outfall
No
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/1
Total Suspended Solids
mg/I
pH,
Standard units
Permit Limit
- t
15 c
So or 100 see permit
"t Withln 6 0 — 9 0
For sampling periods with no discharge at any single outfall you must still submit this discharge monitoring report with a checkmark here
swu 250 last revised April 11 2013
Page 1 of 2
I

0
United Parcel Service Winston 5alem
STORM EVENT CHARACTERISTICS
Date D9/11/2017 to 09/12/ 2017 (first event sampled)
Total Event Precipitation (inches) 117
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches)
Note if you report a sample value In excess of the benchmark, you must Implement tier 1, 77er 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 It SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERM) PART fl SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES F--j NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES E_] NO
REGIONAL OFFICE CONTACT NAME
Mail an original and one copy of this OMR, including all "No Discharge" reports, within 30 days of receipt of the lob 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 INFSIRMATION REPORTED_
I certify under penalty of taw 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
K144413 . - — e,--, I z- ! f f f `7
ISlgnature of Pen it eel {Date)
Additional copies of this form may be downloaded at http //portal ncdenr orPJweb/wa/ws/su/npdessvv#tab 4
SWU 250 Last revised April 11 2013
Page 2 of 2

J
May 1, 2017
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699 - 1617
REC'F/V
Mir o 3 �
z01�
WR SeCF<<SS
r1pN
Re Stormwater Discharge Outiall Monitoring Report (DMR) Year 5, Period 1, Sample 9 - 2017
United Parcel Service — Wmston Salcm
199 Park Plaza Drive, Winston Salem, North Carolina (Forsyth County)
General Permit NCG080000 CertiFicatt of Coverage No NCGO80196
Dear Stormwater Permitting Unit,
We respectfully submit the enclosed original and one copy of the Stornwater Discharge Outfail
Monitoring Report for the United Parcel Service — Winston Salem under General Permit Number
NCG080000 Certificate of Coverage No NCGO80196 This submission is for stormwater discharge
sampling during Year 5, Period 1, Sample Number 9 (January-- tune, 2017) as outlined in Part II,
Section B of our stormwater discharge permit We are happy to report that all sample anal}tical results
were below benchmark values and/or within the benchmark ranges
If you have any questions or comments regarding this Stormwater Discharge Outfail Monitoring
Report (DMR), please contact us at your convenience
Sincerely
Vincent Mollo
District Environmental Coordinator
United Parcel Service, Inc
Enclosures Stormwater Discharge Outfall Monitoring Report (DMR), 1 original & 1 copy

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCG080000
Date submitted 04/18/2017
CERTIFICATE OF COVERAGE NO NCG080196
FACILITY NAME United Parcel Service Winston-Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO INC )
LABORATORY Pace Analytical Services, Inc Lab Cert # 40, 37712 & 442
LABORATORY INENCO Inc Lab Cert # 5540
Comments on sample collection or analysis
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD �X Jan June ❑ July -Dec
or r Monthly' (month)
DISCHARGING TO CLASS EJORW FIHQW F-lTrout DPNA
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitoring Requirements (If applicable)
Zero -flow Water Supply FISA
Other Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
X yes no
❑ No discharge this period ? z
t Outfall t
a; ?1VNp ,vl '01
t 1 ^' jy Date��," �a�
Samnrle Collected+%,,
�,•h9�f1 1
=� mo/dd/yr,,,,�
ao tiFt�k' zs 00530R,T�sc 3 i ey
00400 , � � ^'
r1 "» '�'c,�, ti,-, ,00551i c r �k "V tit'
' �ti iz E j x � i ~1�} Sstf' y X
"h °''Total Suspended' p
ilre Ti
' ^ ix Solids, mg/ IIi ', T�i 61,'
el;j.`" `'x`t pH, t'„,� �,4€�^
tS{1't 1 �11�if
; p r 4 Standard units .
'N6n-Polar Oil and Grease/TPH EPA^
n.�i' lYr�+l �� F`
x ;" Method JL664 (sGT-HEM), mg/L l; '
,, Yt,, WNew Motor Oil Usage
Z�ri 1Ft{ ��s S•kf I
a°,kris' Annual average gal/mot
a
Benchmark
,^M4yir` - c 4 fit
�,t
C } `.a\Sl
k5D or 100 see permit
4 h
Within 6 0-9 0`., '
rtit t, 3{ \�At� 3 y♦
- s �, 15 - {
\k 3>+ k ? �x�l x`f t ,�
_"sAi",, i^ - r
SDO-001
04/03/2017
88
857
< 5 0
159
SDO-002
04/03/2017
73
823
< 5 0
159
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
fi'`S',Outfall as
4 Na
��it �stcs Date"z Yz;�R
Sample Collected; +
s" ma/dd/yr L,
Yk 1 3i;wjl 7rt c,� a D0556s3a'�� � 5, x{
1 ?s �Axa sw 00530,�I.
00400
t ^FNon-Polar Ott and Grease/TPH EPA Method � .�,
s tY Lt3. �` ° fie` s.., a i
a s , `1664 (SGT-HEM), mg/L ` c ° ` x cs�r�
jiital Suspended Solids� S
i lF : i 5\ .p L �+e� ki
x E s " mg/I �c ,.te`rq. ;t ` F
s i V+ ti pH; + s' , ;r
tit i ' r l5 �,: i�" tF
, �' h" Standard units
� Permit Limit
NF�p r,... i- i >ttS,a y
, E , . ,-� � r�
,t t ? Z .� i c L tr " ^, n "? �\
^,. ?a �„ 5 k ,, , Mr,,fi15 � � .,� } ,.�,• t
n � �`t /f i f 6
� ;���, 50 or 100 see'permit �, fiw k
S �i '
'r � Y� �� Within 6 0 - 9 0
i For sampling periods with no discharge at any single outfall you must still submit this discharge monitoring report with a checkmark here
5WU 250 last revised April 11 2013
Page 1 of 2

United Parcel Service Winston Salem
STORM EVENT CHARACTERISTICS
Date 04/03/2017 (first event sampled)
Total Event Precipitation (inches) 107
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches)
Note If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier Z 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
• 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 ANYONE OUTFALL? YES 0 NO rX
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F--] NO rI
REGIONAL OFFICE CONTACT NAME
Mail an oriainal and one copy of this DMR. including all "No Discharae" resorts. within 30 days of receipt of the lab results (or at end of monitorina period in
the case of "No Discharoe" reports) to
Division of Water Quality
Ann 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 penalties for submitting false information including the possibility of fines and imprisonment for knowing violations
Nor
(Signature of
Additional copies of this form may be downloaded at
h /1—)
(flat )
http Llportal ncdenr or web w ws su n dessw#tab 4
SWU 250
last revised April 11 2013
Page 2 of 2

r
Semi-annual Stormwater Discharge Monitoring_Repolt
for North Carolina Division of Water Quality General Permit No NCG080W0
Date submitted 04/18/2017
CERTIFICATE OF COVERAGE NO NCGO80196 SAMPLE COLLECTION YEAR 2017
FACILITY NAME United Parcel Service - Winston-Salem SAMPLE PERIOD OJan-June July -Dec
COUNTY Forsyth or ❑Monthly' (month)
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO, INC)
LABORATORY Pace Analytical Services Inc Lab Cert # 40, 37712 & 442
LABORATORY INENCO, Inc �LabCert # 5540 _
Comments on sample collection or analysis
DISCHARGING TO CLASS ❑ORW F]HQW oTrout F_jPNA
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitoring Requirements (If applicable)
Zero -flaw E]WaterSupply F]SA
EX Other Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
X yes no
No discharge this period ?2
Outfall
No
,•
Date,;
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/I
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage, ,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6 0 — 9 0
15
SDO 001
04/03/2017
88
8 57
< 5 0
159
SDO 002
04/03/2017
73
823
< 5 0
159
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
Outfall
No`"
Date
Sample Collected,
mo/dd/yr
D0556
OD530
00400
Non -Polar Oil and Grease/TPH EPA Method
? 1664 (SGT-HEM), rng/L
Total Suspended Solids
mg/I
's 4 - `pH,
�� " Standard units
Permit Limit
50 or 100 see permit
Within`6 0 — 9 0 ,
i For sampling periods wah no discharge at any single outfall you must still submit this discharge monitoring report with a checkmark here
SWU 250
last revised April 21 2013
Page 1 of 2

United Parcel Service Winston Salem
-fs k
STORM EVENT CHARACTERISTICS
Date 04/03/2017
Total Event Precipitation (inches)
(first event sampled)
107
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches)
Note if you report a somple 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
• 2 EXCEEDANCES W A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART It SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES a NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES 0NO
REGIONAL OFFICE CONTACT NAME
Mail an orrainal and one coov of this OMR. includina all "No Discharae" reports. within 30 days of receipt of the lab results for at end of monitorina period in
the case of "No Discharae" reports) to
Division of Water Quality
Attu 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 penalties for submitting false information including the possibility of fines and imprisonment for knowing violations
i
qI° ] i
(Signature of Permit ) {Datr=)
Additional copies of this form may be downloaded at
SWU 250
Rit 1 r i10rt�li�CGte^_9r�,/Web LV LVS/�tr�rkNreSSI '�tal) •*
last revised April 11 2013
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCGO80000
Date submitted 12/23/2016
CERTIFICATE OF COVERAGE NO NCGO80196
FACILITY NAME United Parcel Service - Winston-Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO INC)
LABORATORY Pace Analytical Services, Inc Lab Cert #1 40, 37712, & 442
LABORATORY INENCO, Inc Lab Cert # 5540
Comments on sample collection or analysis
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD Jan -June 0 July -Dec
or Monthly' (month)
DISCHARGING TO CLASS F—]ORW F_�HCIW Trout OPNA
RECEIVED Zero -flow ❑Water Supply FISA
DEC 2 9 2L i7
�X Other Class C
CENTRAL FILES
DWR SECTION PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitortng Requirements (If applicable)
X yes no
ElNo discharge this penod22
`" wOutfall-a£,k
„�� No �;a'
' {Sample Callecte'd'F�
] �~ r l J7f•
mo/dd/yry 1-,
00530 ; x�
' t, �� . ,
r" �,r 00555 re'
�' ' � Total Suspended},`y'.i, i,
y! }'2i' �~x 1j��~�a 5 �'fi 4�'�1 �
�� Solids, mg/I i f
' �a *- `,�j pH� �z]� Y N {l
i�4� �CiI�,K a���• s�ay.�4 rw
fM, Standard unit53
[�"� Non -Polar OBI and,Gr`ease(f.�1 PH EPA ;�
,µ1 ;� t3��1 R•i � -�}�, V
-Method 1664 (SGT-HEM), mg/L �
` � :�' New Motor Oil Usage,,;
•KV ��O !�l
3;, Annual �average gal/mo 3
`tBerichmark-.
�ht k
� , - ,� ,
[ i
� ., V] 50 or 100 see permit
•;� Within 6 0 —9
lY \� ♦'-A ' ! .<
t VSIt S C Y = t E Zj
SDO 001
11/29/2016
27
765
< 5 0
152
SDO 002
11/29/2016
79
698
< 5 0
152
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
i s ;tOr>utfall q
RtiN'Nay,Sample
`
it �Date, S' tt
Collected; i
t ` rria/dd/yr `
•'1� ',00556
1'% 3 x00530,Y ,�, i <+�'` �_^raab
irx,, �' er' bi•�° bD400'c .._. v'iii�rcr.
_ #� . t Nori-Polar Oil arid Grease/ EPA Method,
t` _ V � \ i ► z � � LS
��� 1664 (SGT-HEM], mg/L at`�°�
t i;, -Total Suspended Solid ss Rr
w ! ' 1 a f,`s a \
,� ., �- `� mg/1; °, ` ' `� t' '
,, �r `PH,
} 1� l. r a
s s Standard units <
1
',Permit Lirrrrt
f \ t•r�..`,ii. 5 r
7 ias. ; t ,� '
' I5 } r J
vsdi :ry tiYr •. ;'r.r G ii }.s , 1j t 4 1 S? u.l f
+ �i _
��Z r SEl or l0U see permit ` a
F�Y
�. £Within 6 0 — 9 0 ` U
k For sampling periods with no discharge at any single outfail you must still submit this discharge monitoring report with a checkmark here
SWU 250 last revised April 11 2013
Page 1 of 2

United Parcel Service Winston Salem
STORM EVENT CHARACTERISTICS
Date 11/29/2016 to 11/30/2016 (first event sampled)
Total Event Precipitation (Inches) 144
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (Inches)
Note if you report a sample value in excess of the benchmark, you must implement Tier 1, Ter 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
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART It SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES 0 NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F7 NO I�
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 I am aware that
there are significant penalties for submitting false information including the possibility of fines and imprisonment for knowing violations
(Signature of Permittee)
Additional copies of this form may be downloaded at
lZ z3 1 1
(Date)
http /portal ncdenr ors/web/ws/ws/su/npdesswt#tab 4
WILTIVIN-1111
last revised April 11 2013
Page 2 of 2

1600 Cottow ood St
Charlotte, NC 28206
October 26, 2015
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699 - 1617
�V6osor`l�
Ens
RECEIVED
OCT 28 Z915
CENTRAL FILES
DVVR SECTION
Re Stormwater Discharge Outfall Monitoring Report (DMR) Year 3, Period 1 Sample 5 - 2015
Dear Stormwater Permitting Unit,
We respectfully submit the enclosed original and one copy of the Stormwater Discharge Outfall
Monitoring Report for United Parcel Service Facilities listed on page 2 & 3 This submission is for
stormwater discharge sampling during Year 3, Period 1, Sample Number 5 (January to June, 2015) as
outlined in Part II Section B of our stormwater discharge permit We are pleased to report that all
sample analytical results were below benchmark values and/or within the benchmark range,,
If you have any questions or comments regarding this Stormwater Discharge Outfall Monitoring
Report (DMR), please contact us at your convenience
Sincerely
se)
David Isadcs 0
District Environmental Coordinator
United Parcel Service, Inc,
Enclosures Stormwater Discharge Outfall Monitoring Report (DMR) for each of the faLlhtleS listed
on pages 2 & 3 1 original & 1 copy

United Parcel Service -Asheville
301 Sweeten Creek Rd Asheville NC 28803 (Buncombe County)
General Permit NCG080000, Certificate of Coverage No NGG080177
United Parcel Service — Charlotte
1600 Cottonwood St Charlotte NC 28206 (Mecklenburg County)
General Permit NCG080000, Certificate of Coverage No NCGO80178
UPS Ground Freight Inc - Charlotte
5204 North Graham St Charlotte, NC (Mecklenburg County)
General Permit NCG080000, Certificate of Coverage No NCGO80309
UPS Ground Freight Inc — Conovcr
150 Lap Rd NE Conover NC 28613 (Catawba County)
General Permit NCG080000, Certificate of Coverage No NCGO80304
United Parcel Service — Durham
2008 Fay St, Durham, NC (Wake County)
General Permit NCGO80000 Certificate of Coverage No NCGO80382
United Parcel Service — Greensboro
3100 Flagstone Dr Greensboro NC (Guilford County)
General Permit NCG080000, Certificate of Coverage No NCGO80181
United Parcel Service — Greensboro 1`reight
4411 Groometown Rd Greensboro, NC (Guilford County)
General Permit NCGO80000 Certificate of Coverage No NCGO80302
United Parcel Service — Hickory
1224 26'h St S E Hickory NC 28602 (Catawba County)
General Permit NCG080000, Certificate of Coverage No NCGO8061 1
United Parcel Service — Hope Mills
3439 Black and Decker Road, Hope Mills NC 28348 (Cumberland County)
General Permit NCGO80000 Certificate of Coverage No NCG080370
UPS Ground Freight Inc — Morrisville
150 International Drive Morrisville NC 27560 (Wake County)
General Permit NCG080000, Certificate of Coverage No NCG080659
2

United Parcel Service — Raleigh
2101 Singleton Industrial Drive Raleigh NC 27604 (Wake County)
General Permit NCG080000 Certificate of Coverage No NCG080378
United Parcel Service — Rocky Mount
1108 Instrument Drive Rocky Mount NC 27804 (Nash County)
General Permit NCG080000, Certificate of Coverage No NCG080 379
United Parcel Service — Southern Pines
202 Air 1 ool Drive Southern Pines, NC 28387 (Moore County)
General Permit NCG080000, Certificate of Coverage No NCGO80380
United Parcel Service — Statesville
147 Parcel Drive Statesville NC 28625 (Iredell County)
General Permit NCG080000, Certificate of Coverage No NCG080190
United Parcel Service — Winston Salem
199 Park Plata Dr, Winston-Salem, NC 27105 (Forsyth County)
General Permit NCG080000, Certificate of Coverage No NCGO80196
3

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality Genera! Permit No NCG080000
Date submitted 10/23/2015
CERTIFICATE OF COVERAGE NO NCGO80196
FACILITY NAME United Parcel Service Winston-Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO INC )
LABORATORY Pace Analytical Services, Inc Lab Cert # 12, 40 37706 & 37712
LABORATORY INENCO, Inc Lab Cert # 5540
Comments on sample collection or analysis
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD FX Jan June ❑ July Dec
or ❑Monthly' (month)
®�CDISC*+A�
o1NGTOCLASS E]ORW ❑HQW Trout �PNA
i OCT
2 8 Z ��iGG� zero -flow E] Water supply ❑SA
CENTRAL FILES
❑VVR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ X Other Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
X yes _ no
No discharge this perrod22
�Outfall ��
i �'� �,isey�r^� by
i�xf�{ijDate�alr(jh
iP"' ,�'r�.r 7E'f��?k�4\ \'
�j�Sample,Coll'lecte& ,5t
,ji�3}00530 atxy}�frj}'v"
).? fStt�kS � gtii y�T, •'ail
:fi3 ,'tS sir 00400�xFt ei"f�J A
+�i F Ctr3.F %x���ef
pis3:jo-[9 aR Hz ��+r�r� 31
FZ� ��S�Ei JiF ,600556 C � ;>?iC'i'� sil.�
tF "�` " ��a�a c, ,,, t� n:
fr'i�:�'� ', �'1:rh.Rna���j� 5v'�i
\>( 'Totall{Suspended„+, "
i � r CZi�
Solids, mg/I, , 4,ja,,;A
�. T ,
, � � Standard units Y, �
4NantiPolar,dil and Grease/TPH EPAr
,� `mil RlC4�.h R� ]l 3-. 1
r , yMathod 1664 {SGT-HEM}; mg/L S=s
, ;�� New Mato Oil Usage,5�
t, itSR�j' ti 't"i
i �, a ',Annual average,gal/mop �z z
)4Benehmark,�
�
rs'! r�*�.F„ r. w
x t � n �\ � ,, a � r,
A v `rE�
50 or`100 see`permith z�,,r
F ,�
�� h �Withrn fi 0 a 9 0 _ 4,t
r +aF� fi j� ��ld �� t�15 � �s �„- "��, ��,
is ='_��� il �t �;<t�• ,'�� � �
SDO 001
04/25/2015
< 2 5
842
< 5 0
157
SDO 002
04/25/2015
627
820
< 5 0
157
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
Outfall'e',"
n e,1 No-, +� a
}�rs1
'sp r ;
1)Samp1 Callec�ted
�� a,�n
r��� e�
_ _
i 00556��r
A4k00530
4 04'. i� R�
n , �'� rNon`Polar Oil and Grease/TP,�H EPA Method ;i }
�1z 1664� 5GT�HEIV1� iii 1r z'tit r�°ai,
'
�} �_ �� ( 1, B/k ��bF}z•i u
3�1 �?�� Total Sus ended Solids ' +4 ��
'�,��r r p'�31��# g5,
a� — t��w t
r \ ,'�" m I�tizsti
; �" y' pHs4r F iY;
�,,'�1;x �u/i etE'
3ri�B� Standard units ak
5
't Per`mrt Limit
7 t `li ,� < "q ,. ix],r�r
4 r „ -, "� ti
-� t,z 1^ ,: i"- ` i'+,K -. v ,e. .'_ ti R- �v
� e ! , ., ;� , ,�" ~. -15 , t =, ,3'! �R] � � • � r t
L� i
�• �s ree permit(
„ , ,50 or IOCsee . �,;�� ,
_,. '0,,'
, e � � � r,.Wrthin ,fi r0 — 9 0 ;
' For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here
SWU 250 last revised April 11 2013
Page i of 2

STORM EVENT CHARACTERISTICS
Date 04/25/2015 to 04/26/2015 (first event sampled)
Total Event Precipitation (inches) 010
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (Inches)
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
• 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 ANYONE OUTFALL? YES F7 NO FT
IF YES HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES 0 NO 0
REGIONAL OFFICE CONTACT NAME
Mail an onainal and one copy of this DMR, including aft "No Orscharge" reports, within 30 days of receipt of the lob results for at end of monitoring period in
the case of "No Discharge" reports) to
Division of Water Quality
Attn DWQ Central Files
1617 Mad 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 penalties for subrry6iW false information including the possibility of fines and imprisonment for knowing violations '
(Signature of Permatee}
Additional copies of this form may be downloaded at
t
0 /19/1
(Date)
7-
http //portal ncdenr orl;/web/we/ws/su/npdesswfitab 4
$WU 250
last revised April 11 2013
Page 2 of 2

Semi-annual_Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCGO80000
Date submitted 07/25/2016
CERTIFICATE OF COVERAGE NO NCGO80196
FACILITY NAME Uniteo Parcel Service Winston Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO, INC)
LABORATORY Pace Analytical Services, Inc Lab Cert # 40, 37712, & 442 FC;L f V L-D
LABORATORY INENCO, Inc Lab Cert # 5540
Comments on sample collection or analysis i
C _,,TRAL FILES
DWR SECTION
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD ❑X Jan -June ❑ July Dec
or ❑Monthlyi (month)
DISCHARGING TO CLASS [:]ORW [:]HCIW Trout F_jPNA
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitoring Requirements (If applicable)
Zero -flow mWaterSupply MSA
MX Other Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -)
x yes no
No discharge this period ;,2
Outfall
No
�` Date`
'Sample Collected,
mo/dd/y'r
,<^ 00530 �"
- 00400
z- s ;'00556. `,s 4r
< _ 4�- „ 1, r 4 - ^
,Total Suspended F-
Solids, mg/I
�? pH, +
Standard units
Non -Polar Oil and Grease/TPH EPA
Method X664 (SGT-HEM), mg/L +
4 New Motor Oil Usage," j
Annual average gal/mo
Benchmark:
- °,
'x 50 or 100 see permit
Within 6 0 - 9 0
>-_ 15
J - `}
SDO 001
05/17/2016
42
858
288
152
SDO 002
05/17/2016
39
736
0 678
152
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
Outfall
No
Date
^ Sample Collected,
v
rno/dd/yr
00555
100530
00400
Non -Polar Oil aM Grease/TPH EPA Method , ` -
C t .
' " j�11664`{SGT-HEM)3Cti<, mg/L}
Total Suspended Solids
`' mg/1. ~; ;' 3 `��
_ _ ; pH � tS ,
�r �l
Standard `unitsA '
Permit Limit
-
^} is
5o or 100 see permit
Within 6 0'- 9 0
i For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here
I
SWU 250 last revised April 11, 2013
Page 1 of 2

United Parcel Service Winston Salem
rti
STORM EVENT CHARACTERISTICS
Date 05/17/2016 (first event sampled)
Total Event Precipitation (inches) 0 S5
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches)
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 [I 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 ANYONE OUTFALL? YES E] NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F—� NO
REGIONAL OFFICE CONTACT NAME
Marl an original and one copy of this DMR, includina all "No Discharae" reports, within 30 days of receipt of the lob results for at end of monitoring period in
the case of "No Discharae" reports) to
Division of Water Quality
Attn DWQ Central Files
1617 Mad 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 property gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, orthose 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 '
J� -t �- / W,/- I e: 2 -9/-// A �
(Signature of Per ee) (Date)
Additional copies of this form may be downloaded at http /!portal ncdenr ore/%.reb/wg/ws/su/npdessw#tab 4
SWU 250
last revised Apnl 11 2013
Page 2 of 2

UPS Facility Location
Inspector
Signature of Inspector
NON-STORMWATER DISCHARGE EVALUATION
PC I- ) IDS ��� } �PL(r-
Storm Water Discharge Outfall Locations
Outfall location ID =,�D — p Q
Outfall Type Ditch CP
e Outlet Pipe Inlet
Catch Basin Curb Inlet Other
1 Is the outfall free of any non stormwater discharge?
If no describe
Inspection Date
le�1���
Pond to Ditch Outlet Pond to Pipe Outlet
2 Identify potential sources of any non stormwater discharges observed or discovered
3 Method(s) of evaluation isual Dye Test Storm sewer map review Other
Comments
Outfati Location ID SEY-)— CID Z
Outfall Type Ditch Pipe Outlet Pipe Inlet
Catch Basin Curb Inlet Other
1 Is the outfall free of any non-stormwater discharge?
If no describe
yes No NA
Pond to Ditch Outlet Pond to Pipe Outlet
2 Identify potential sources of any non stormwater discharges observed or discovered xja�
3 Method(s) of evaluation Visual Dye Test Storm sewer map review Other
Comments
No NA
NC�080000 Part 11 Sections A I(e) & A 7(b) SPPP Non Stormwater Discharge Evaluation — Appendix IF Page 1 of 1

May 9 2016
Divi,,ion of Water Quality
Attn DWQ Central files
217 We,,t Jones Strcet
Raleigh NC 27603
RECEIVE
MAY Z 4 2016
CENTRAL FILES
DWR SECTION
Re Stormwater Discharge Outiall Monitoring Report (DMR) Year 3 Period 2 SarnplL 6 - 2015
United Parcel Service — Winston-Salem 199 Park Plaza Drive W-S NC (I,orsyth County)
General Permit NCG080000 Certificate of Coverage No NCG080196t
Dear Stormwater Permitting Unit
We respectfully submit the enclosed original and one copy of the Stormwater Discharge Oulldll
Monitoring Report for the United Parcc,l Service — Winston-Salem facility under General Permit
Number NCG080000 Certificate of Coverage No NCG080196 I his submis,,ion is for stormwater
discharge, sampling during Year 3 Period 2, Sample Number 6 (luly to December, 2015) as outlined in
Part II Section B of our stormwater discharge permit We aie happy to report that all sampl(-
analytical results were below benchmark values and/or within the benchmark ranges
If you have, any Quc,,tion,, or comment,, regarding this Stormwater Discharge Outlall Monitoring
Report (DMR) plea,,c contact us at your convenience
Sincerely
Demetrius Wilkins
District Environmental Coordinator
United Paieel Service Inc,
Enclosure,, Stormwater Discharge Outtall Monitoring Report (DMR) 1 original & 1 copy

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCGO80000
Date submitted 04/15/2016
CERTIFICATE OF COVERAGE NO NCGO80196
FACILITY NAME United Parcel Service Winston Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO INC )
LABORATORY Pace Analytical Services, Inc Lab Cert i# 12, 40 37706, & 37712
LABORATORY INENCO, Inc Lab Cert i# 5540
Comments on sample collection or analysis
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD Jan -June 0 July -Dec
or 7 Monthly' (month)
DISCHARGING TO CLASS F]ORW F_�HQW Trout F_jPNA
RECEIVED
MAY 2 4 2016
CENTRAL FILES
DWR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitoring Requirements (if applicable)
Zero -flaw OWaterSupply EJSA
FX]Other Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
X yes no
❑ No discharge this period?2
a� Outfall
tt Nos�
# � .
Dates ,' ;. �E
Sample Collected, t
;� mo dd rF,rv`1 �;�
' / /y ,
�,� 5 00530 " t�h; z `�r=
f'` ` ' 00400.
00556T ,t,
�Total Suspended�r`pH;`
't' Solids, m I� `
g/
b,'^I y
Standard
,, ;;i2 + 4
�,"Non-Polar,Odaand Gee a/TPH EPA 3
` ` �
�� , Method 1664 (SGT-HEM], mg/ i
{ #New Motor Oil Usage;ir
y� ' rage
�, Annual average gal/mo
Benchmark >
'S�`
`:; 1r = }} ' t r
. i" ` 50 or 300 see permit,
I
, ,,lWithm 6 0— 9 0 �` lK�
�`~�+ti �"t�� F rt 'k; rj 15's�� , " `•� �`
"7 ' "�
zi n
SDO 001
10/27/2015
81
8 36
< 5 0
157
SDO-002
10/27/2015
116
704
< 5 0
157
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
tiNX�'S��
;Date
a�•
:SapeCollected„s''��a�"OddGrease/TPHEPA��h
mo/dd/yr i-
t-s'h s r�Fa�-S ,.; 005561. iTar f ,
" .00530?
.00001 ��tiOut#allqa, 1 n
yY z,
`` ;,.�_�,, 1664 (SGT-HEM) mg/L t
r e;
i'trupended�5olid��p'i��Fytr
_ �,s mg/I c 1
N
xxF ,n H
Standard
" Permit Limit
��'� y , �' car ,
` tc
�!;' �^ Cst�s f � tip t� w _ a5 € F
� �,_ ���_. �,, =15 , a3 � � a.,� �,z ;* , �
Y < `i h } l' � 2
� µ , 50 or 100`see permit t+ _I,
1 tr " A `
� � Within 6 0 — 9 0
I For sampling periods with no discharge at any single outfall you must still submit this discharge monitoring report with a checkmark here
5WU 250 last revised April 11 2013
Page Iof2

United Parcel Service Winston Salem
STORM EVENT CHARACTERISTICS
Date 10/27/2015 to 10/28/2015 (first event sampled)
Total Event Precipitation (Inches) 118
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches)
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
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 ANYONE OUTFALL7 YES NO F
IF YES HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F] NO
REGIONAL OFFICE CONTACT NAME
Mail an original and one copy of this DMR.- including all "No Discharge" reports, within 30days of receipt of the lob_resultslor at end -of monitoring period 1n
the case o "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 penalties for submitting false information including the possibility of fines and imprisonment for knowing violations'
(Signature of Permittee)
Additional copies of this form may be downloaded at
LOCI -f G
(Date)
http /,portal ncdenr org/web/wgfws/su/npdessw#tab 4
5WU 250
last revised April 11, 2013
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCGO80000
Date submitted 04/10/2015 - t copy
CERTIFICATE OF COVERAGE NO NCGO80196 1 V jAr ,E COLLECTION YEAR 2014
FACILITY NAME United Parcel Service - Winston Salem APR Z 3 20eMPLE PERIOD ❑Jan -June ❑X July -Dec
COUNTY Forsyth CENTRAL FILES or ❑Monthly' (month)
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO INC J CwR SECTIO t*ISCHARG ING TO CLASS ❑ORW F-]HQW Trout F_jPNA
LABORATORY Pace Analytical Services Inc Lab Cert # 12 40 37706 & 37712
LABORATORY INENCO, Inc Lab Cert # 5540
Comments on sample collection or analysis
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitoring Requirements (If applicable)
Zero -flow ElWaterSupply EISA
Other Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
x yes _ no
❑ No discharge this period22
Cr
f� z �fOijtfall. �'�,
t
No z <K
1°'F�
;�;�^ �.�Zz`�'Date, ��. ,� s
M ;Sample Collected,'
ri ild/yr st
y-'f c r.b: a,� i �i a
�',. , 4r � � � c OD53D 1 = i� � ,hit
b ^* Trl
s � �.a.,' f00400:
`, x Total Suspended
:-r Solids, rnVl
I-61
Standard units
E'., Non -Polak Oil and Grease/TPH EPA,
a,r Method 1664 (SGT-HEM), mg/Lw,
�� �, New Motor Oil Usage, , �*�
? n Annual a►ierage gal/ma R
`Benchmarks+
a `��
50or,100seepermit"-,�,
., ; ``
t WithinbD=9D�
S00 001
10/03/2014
144
850
< 5 0
152
500 002
10/03/2014
99
762
< 5 0
152
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
k Outfall"", IN
*t;Mv� `.
1 'r„ 4 r a7atet� y, ,� n
r Sample Col#e� ted
dd/yr�
" <�,f =' ' '# � �` � " t� ,, 00556 f.s, -,., a ' t
�,t ;, � v� 00530 .�#
,»�O;004001r , t T l'X I
Non -Polar Oil and G'r'ease/TPSH EPA Method. y I% NA;`
.''� y 1664 (SGT-HEM), mg/C- ti . .`
�;.: Total Suspended Solidse�. i;
it ,, :' } ,�: a�� < <mg/I —, ` '.:
�' a )H,, t; r
:����s Standard units
i Permit Limit'
�� �:;, :< "z`��
i `� «z": �� ""'lo;r," 15.1V a 46". ``lu" Z1k 4},.h; c'
. �: 1� '�50 or 100 see permit �1k`leE ,`'
max§ Withrny6 0 = 9 O
i For sampling periods with no discharge at any single outfall you must still submit this discharge monitoring report with a checkmark here
SWU 250 last revised April 11 2013
Page 1 of 2

STORM EVENT CHARACTERISTICS
Date 10/03/2014 (first event sampled)
Total Event Precipitation (inches) 032
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (Inches)
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
• 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 ANYONE OUTFALL? YES = NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES = NO
REGIONAL OFFICE CONTACT NAME
Mail an original and one copy of this DMR mcludin all No Dischar e" rg arts within 30 days o receipt o the lab results or at end o monitorin errod in
the case of _"No Discharge" reporaj 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 penalties for submitting fa
ISegnature of Permitteej
Additional copies of this form may be
rmation including the possibility of fines and imprisonment for knowing violations
(Date
ed at htt ortal ncdenr orp,/web/wg/ws/su/npdessw#tab 4
SWU 250
last revised April 11 2013
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality Genera! Permit No NCG080000
Date submitted 07/11/2014
'CERTIFICATE OF COVERAGE NO NCG080196
FACILITY NAME United Parcel Service Winston-Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Rvan R Osborne IINENCO INC
LABORATORY Test America Laboratories Inc
LABORATORY INENCO Inc
Comments on sample collection or analysis
Lab Cert # 269
Lab Cert # 5540
SAMPLE COLLECTION YEAR 2014
SAMPLE PERIOD 5X Jan -June ❑ July -Dec
or Monthly' (month)
DISCHARGING TO CLASS ❑ORW F—]HCIW 7Trout DPNA
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month)
Part A Vehicle Maintenance Areas Monitoring Requirements (If applicable)
Zero -flow E]WaterSupply FISA
Other Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
X yes no
❑ No discharge this period?2
}�, �,,
,s0utfall
r� FNoI� j
a ;
,>v��
ly L l..,t .#%, q'At
) � r Date a , ,f
t
its':r�:
Sample Collected,
T
mo/dd/yr w , ,
y rko- [,k , t\` R ,`1"Y'��t�
1. , V,k 4� 00530� �t �,
i -�'
pit �, ,00400y" ��� ,
�i'411 '3at1r T-
tin �� ��.� OOSS6+; z >c r��
s
f �k.�,a; . +s z��r�t� ) ,x k ' )e.,s�
Total Sus ended i,' t''r
p ,
y�� f �p
kti -Solids, mg/13 t,
H °' '>�
, p . F
�y, '1 i y4
i1L.5Standard units �) s�
` Nnr%Palar,011 and Grease/TPH EPA
i. !
Method 1664 (SGT-HEM), mg/L�
,
�� New Motor Oil Usage; er
) ) =O'er , 1
�,�? ,, Annual average gal/mo I
mBenchmarkh
'rkE� ; ; t , - „L «,?` ;�
,; t'50 or`100'see ie�mlt�"",
,s 1 I,Within 6 0 : 9 ok",*l
r a`kP°* fi r'Q���h�,t 15 r ' is f�# ���°
'� � ^� `i�S;` k-1 4 hi `rs` P "N-M, =:
SDO-001
04/07/2014
110
818
< 2 4
152
SDO-002
04/07/2014
980
773
< 2 4
152
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
' outfall ^t
� �y Noy
"Date, `
` i � .. � c
,, j�Sarn�le%Colle( ted;, �
1J��,jI�..ds`t.s[.'Ml.'YyZf
,t +rmo/dd/yr �`n
� � ' 00556 � ? ` ` a � x, ;
4 •. "; ��+r,,. tiF 1 ti i, � s�:o-� ^ i. « tk
4 ; , � �� ° 00530
,. a .r. � - � ti
� rR >,- Non-Polar,od and Grease/TPH EPA Method Q t'' �°1
�f kz1664 (SGT HEM), mF,f L ' � � z =a '"
+,
� 'Total Suspended 4S%oEyrds`r8f
"i R
`, �i � r �, `m mg/I o
1 l�7 ', pli"s 2y� i'� (fi
�.�y i'1-Eti`
"'Standard units tf�
@ Permit Limit
j
c
t 15 .� ' : >,
`a 5 a
n i ' So or 1o0 seePe rmrt - ,
Within 6 0 — 9 0 �` N'
RECEIVED
1
i For sampling periods with no discharge at any single outfall you must still submit this discharge monitoring report with a checkmark here
SWU 250
0ENR-LAND QUALITY
STQRMWATER PERMITTING
last revised April 11 2013
Page 1 of 2

STORM EVENT CHARACTERISTICS
Date 04/07/2014 to D4/08/2014 tfirst event sampled)
Total Event Precipitation (inches) 159
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (Inches)
Note If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, artier 3 responses See General permit text
FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART fI SECTIONS
+ 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 ANYONE OUTFALL? YES F7 NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F-] NO fI
REGIONAL OFFICE CONTACT NAME
Mail an orrgrnal and one copy 9L this DMR, including all "No Discharge" report_ within 30 days of receipt of the lab resents for at end of monitoring period rn
the case of "No Discharge" reports) to
Division of Water Quality
Attn DWQ Central Files
1617 Mall 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 mformsiLgn th ni rmation submitted is to the best of my knowledge and belief true, accurate, and complete I am aware that
there are significant penalties fWsubmittiKg fa
(Signature of
Additional copies of this form may b/downloaded at
including the possibility of fines and imprisonment for knowing violations
http //portal ncdenr org/web/wg/ws/suLnpdessw#tab 4
w
SW U 250
last revised April 11, 2013
Page 2 of 2

Semi-annual Stormwater_Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCG080000
Date submitted 07/11/2014
,CERTIFICATE OF COVERAGE NO NCGO80196
FACILITY NAME United Parcel Service Winston Salem
COUNTY Forsyth
PERSON COLLECTING SAMPLES Ryan R Osborne (INENCO INC
LABORATORY Test America Laboratories Inc
LABORATORY INENCO Inc
Comments on sample collection or analysis
Lab Cert # 269
Lab Cert # 5540
SAMPLE COLLECTION YEAR 2014
SAMPLE PERIOD Jan -June July -Dec
or OMonthlyl (month)
DISCHARGING TO CLASS DORW [:]HQW 7Trout F__]PNA
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A Vehicle Maintenance Areas Monitoring Requirements (If applicable)
Zero -flow oWaterSupplyEISA
Other Class C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 3
X yes no
❑ No dischorge this period? 2
Outfall
No
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/1
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6 0 — 9 0
15
SDO 001
04/07/2014
110
818
< 2 4
152
SDO-002
04/07/2014
980
773
< 2 4
152
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
outfall
No
Date
Sample Collected,
mo/dd/yr
D05S6
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT HEM), mg/L
Total Suspended Solids
mg/I
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
Within 6 0 — 9 0
i For sampling periods with no discharge at any single outfall you must still submit this discharge monitoring report with a checkmark here
5WU 250 last revised April 11 2013
Page 1 of 2

STORM EVENT CHARACTERISTICS
Date 04/07/2014 to 04/08/2014 (first event sampled)
Total Event Precipitation (inches) 1 S9
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches)
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 11 SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART 11 SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES F7 NO F7X
IF YES HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE7 YES F7 NO
REGIONAL OFFICE CONTACT NAME
Mail on onCinal and one copy of this DMR, includina all "No Discharae" reports, within 30 days of receipt of the lob results for at end of monitorma period in
the case of "No Discharae" 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 inform n th of +nation submitted is to the best of my knowledge and belief true accurate and complete I am aware that
there are significant penalties f�ubmitti g fa! or don including the possibility of fines and imprisonment for knowing violations
< � f �/ llrz � /7-'�
ISignature of Permit a (Dat
Additional copies of this form mly downloaded at http Uportal ncdenr org/web/wg/ws/su/npdesswa`tab 4
a
SWU 250 last revised April 11 2013
Page 2 of 2