NCG080211_MONITORING INFO_20141013

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
El HISTORICAL FILE
2} MONITORING REPORTS
DOC DATE
❑ � � � y � v �
YYYYMMDD

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Qui ity General Permit No. NCGO80000
q
Date submitted
CERTIFICATE OF
FACILITY NAME
COUNTY (,�
PERSON COLLE(
LABORATORY_
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR U
SAMPLE PERIOD ❑ Jan -June N July -Dec-,
or ❑ monthly' (monthl
DISCHARGING TO CLASS []ORW DHQW '[]Trout L_JPNA
Dzero-flow Elwater Supply OSA
RECEIVED E]Other
OCT f 3 2014 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES
DWR SECTION
E] No dischorge this period'
Ouffill. A
bi
f N'
--d PY _a�
�-5,-� 6 5
z
.,,,.,.ota Stuspen 'd —d'
6reiii0r;r.VH1PX--,�.
r4ink,Mcif6jr Oil;U
0,
S*hple,Collided.
dd/ jr
'v fid ;�jVL
04%RM
Meihb& SG T
4
mo,
.46 g-
16r. -HEM r nji0r4
54
nnua average ga.
13 e i h - k
mar
ltwit- K6 9
?. F
permit.,
9 1
676
3r,>o
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes —no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
-1Z p
k�; affioldX-oll&t"d-
06-5 1-3
0 ar-i I
Wt
—Tota'Sus pefiddcl'S61id
jV
Stafid5rd,uni •
-riri it Li i� it �
Pe
k- X
perm
F7a77
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 October 25. 2012
Page I of 2

0 0 0
STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Iven5recipitation (inches):
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, filer 2, or Fier 3 responses. See General Permit text.
FOR PART AAND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS, SEE PERMIT PART tl 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 ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail on on final and one coey ot this DMR including all "No Discharge" rei2orts, within 30 days of receipt of the lob results or of 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 rAnalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
D -io /�
(Date)
Additional copies of this form may be downloaded at: http:/lportaI.ncdenr.org/web/wq/ws/suZnpdessw#tab-4
S W U-250
last revised October 25. 1-012
Pa4e 2 of

Semi-annual Stormwater Discharee Monitorine Report
Q for North Carolina Division of Water Qu lity eneral Permit No. NCG080000
Date submitted
CERTIFICATE OF COVERAGE NO, NC O8 C% C`- SAMPLE COLLECTION YEAR
FACILITY NAME _ l -S SAMPLE PERIOD ® Jan -June ❑ July -Dec
r �
COUNTY C - v or ❑ Monthly'- _ (month)
PERSON COLLECTING SAMPLES 150)1- 2 DISCHARGING TO CLASS ❑ORW _❑HQW ❑Trout ❑PNA
LABORATORY Cf-., Lab Cert. # • - C.G " ' 1 / 1� ❑Zero -flow ❑Water supply [:]SA
Comments on sample collection or analysis: V �( D ❑Other
MAY 12 2q 14 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Vehicle Maintenance Areas Monitoring Requirements CENTRAL FILES ❑ Afo discharge this period'
DWQ/$OG
_ tfaff
-No
- -_
Dt:
5"ample Collected,
mo/dd/yr
w=
5030
0
¢--5-56`
00-
TO Suspended__
;Sol>4,:mg/1;;-
Standard units
Nona?olar Oil and;Grease/-TPH EPA.
M_etEiod 16fi4 (SGT.FI M),;mg/L
_ .lVew MotorO.ilalsage,_
Annual averagegal�rno
Benchmark-':.�_-
-- -
:50or.1QQsee'permit
Within,6;0;..90•,s=`
- - 15
-
ti
I
�
f
Did this facility perform Vehicie Maimenance Activities using more than 55 gallons of new motor oil per month? Vyes _no
(if yes, repor, your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Sulk Stations and Terminals
Qutfalf_:
kw I" No.
�;,-:,:•Date s =: -""
--sample Collected, .
mo/dd/yr -
00556 _ .�
rQ0530 ::: '._:
00400.
l- Nan,Pola;011:ari� Grease/TPH EPA Method
[SGT=HEM), mg/L
Total Stisperided Solids,phi,•-
Standard`pntts
Permit Limit
: ,..;.;.._
15 ;^.:. .....::..:.::.
.4= 50'tii 10� "see permit
6=0 - 9.0
For sarmp;,ng weriods :vith no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
last revised October 25, 2012
Cage 1 of 2

STORM EVENT CHARACTERISTICS:
Date 41:�fik (first event sampled)
Total Event recipitation (inches):r
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, orTier 3 responses. See General Permit text,
`0 T R RESULTS:
TRIGGERS TIER 1 REQUIREMENTS. SEE?F:RM1T PART 11 SECTION B.
XCEEH)Ai•iCES 1`. A. EC' M FO7 i THE SA-� „ ?ARAWE T ER AT THE SAl^E OUTFAIL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
TIER 3: ;i + "DU? : n=!Ls t ; F?F J 4 OR i��c�RE BENCH,viARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES 7. NO cj
1= yES, ...': 1_1 CO,`1T :THC T'HE U'::Q nEG'C1XAL CF'rlCf? YES I% NOD
Mail an original and one copy of this DPAR,_includr'n_o all No Discharge" reportsvviThin 30 dov_s of receipt of the lab results for at end of monitorino period in
the -case of "No Discharge" reportsJ_to:
i•:isicn c"l:at_rfl:�alir,•
Hes
Cente:
1-7
YOU lkAUST SIGN T:-i1S CERTIFICATION WR ANY INFORMATION REPORTED
dacurc_nt and all attachr-.eats were prepared under mydirection or supervision in accordance with a system designed to assure
P_,Sonr,e! crcceri; 2at.,Er and e-aiur.e the Inforrnaticn suornitted. Based on my inquiry of the person or persons who manage the system, or those persons
:I: re;��nsi_le rc: Satner;r.k thze infxma:icn, : e i zermatior, submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
c - 2"Y1T1 _3�,: :? I �___ ,.,; _c�ri-ing false infarrr:at;on, inclucing the aosssibi#ity o; fines and imprisonment for knowing violations."
(Signa'ure of Perm.ittee)
(Date)
arrass+v�tab�4a::o a3; -r",.egr
!as! revised October 25, 2012
Page 2 of 2

Fa --
Semi-annual Stormwater Dischame Monitoring, Report
for North Carolina Division of Water Qu lity eneral Permit No. NCGO80000
W&oo O 01 ` Date submitted rid, i
CERTIFICATE OF C ERAGE NO. NCG08pi P_ LC)_ SAMPLE COLLECTION YEAR —QD 1 i
FACILITY NAME G -S SAMPLE PERIOD [giJan-June ❑ July -Dec
COUNTY or [] Monthly'_ _ Cmonth)
PERSON COLLECTING SAMPLES - L DISCHARGING TO CLASS DORW ❑HQW [Trout ❑PNA
RECEIVE
LABORATORY_ G►x-b Lab Cert. €i ❑Zero -flaw ❑Wafer Supply ❑SA
Comments on sample collection or analysis: ❑Other
MAY 12 2014 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A- Vehicle Maintenance Areas Monitoring Requirements CENTRAL FILES ❑ No discharge this period'
DWQIBOG
•J::. -
C�utfell`"
_ _ _ - zN:• _'.i
=;Daate:
iT'_. _ •
:: 0530 ,� �;
=a' ._l _
00400 5
ilk — - 1k1_m -•
D0556 � r
_ ..�
:' r _
;�rl11o: _
Saiftple Collected,-
„<,: _
' Total'Suspencfeti
- , pit;= �=--
Von=Polar Dii ario Grease/TPH:EPA
New Motor:Oil.U5age,
mo dii yr
Solids° m L t
- Staniiard.units
. IlRettiod;1664 SGT=HEM rn LF- z;r
Annual avers e als mo _,
Benchmark
0__Osee permit,
Within 6.0 -:9:0
1:
2
i 04
3
, . 0
L4 Dof
I
I
�
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? & yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
--�- - -
��LOutfall�.;��i
hla
- -- = w.
�i)ate���•
�c
1' mpie Colte ted,
- - _r:-_.-. - - - _ •„fir;- _". ..�'^_.1
`:,-�"=`' - �:,U055_-�"•--_ =�•�� �:'.e
Via`- _C,a �_,. zEr•_.'"sa•--- -
• • 00530=• ''
- --
•.. .00400 -
`r0iliand'Grease :TP.NsEPA'Method
No�j=Pola_ _ t 1
(SG7-HEM).
TotaB6s p endid'S Lids ,..,
p
-
I. Perrnit Lirnif 'Ic
=
see permit
bo
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.
Siij-25u
last revised October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 4Event
(first event sampled)
Totalcipitation (inches): - ` as
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.
FCR FART 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 ATTHE 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 ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one cosy of this DMR,_induding all `,_No Discharge" reports, within 30 days_of receipt of the lab results for at end of monitarina period in
the case of "No_Discharge"reports to:
Divisicn of Water Quality
A.t:n: DVJQ Central Files
1617 Nizil Service Center
Raleig =dorth Carclina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certi", . 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 cualiiied personnel'properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
tires-ly resconsitle for gathering the informaticn, -he irforr-nation submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there ayv significant Wallies for submi:,ing false information, including the oossibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: hnn://portal.ncde,-kr.org/web/wgi:vs/su/npdessw#tab-4
SR a-250
last revised October 25, 2012
Page 2 of 2