NCG080334 DMR SW

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted
CERTIFICATE OF CNO NC 08 0 3 3 7
FACILITY NAME 7vKiFX s ;Tu z, A/„+ w
COUNTY is
PERSON COLLECYiVG SAMPLES
LABORATORY 1✓ea Lab Cert. #-/IC- gc12-Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR _ o;Loj•r
SAMPLE PERIOD 0Jan-June 0 July -Dec
or []Monthly' (month)
DISCHARGING TO CLASS []ORW [:]HQW []Trout []PNA
RECEIVED Zero -flow ❑Water Supply []SA
JUL as '1015❑Other
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? dyes 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
Outfall
No.
Permit Limit
Date
Same N Collected,
mQ/dd/Yr
- -
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE ->
Part A: Vehicle Maintenance Areas Monitoring Requirements
DWR SECTION
F]No discharge this period'
Guth
Date
00$30
00400 _ 00556-
IVo.
$ample. �gll2cted,
Total Suspended
pH, -Polar Oil and: Grea9e/TPH EPA
Nor. Motor Oil Usage,
ehfriark
m9 dd/yr.
=
Solids;-mg/L
Standard units Method 16f4.(SGT-HEM), m L
annual avers a I/mo
SO or 1q0 see errnit
Witifiln 6.6'",:P. 15
7,7
-710 u_ P,
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? dyes 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
Outfall
No.
Permit Limit
Date
Same N Collected,
mQ/dd/Yr
- -
00556
Non-Polar011 and.drease/TPH 60A Method
1664 (SGT-H9M),,ntg/L ,
15
00530
Total Suspended Solids,
mg/L
50 or 100 see permit
00400
pHA
$taodard-units
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.
S W U-250
last revised October 25, 2012
Page I of 2

STORM EVENT CHARACTERISTICS:
Dateb —9 /" (first event sampled)
Total Event Precipitation (inches): i --L_
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, rer 2, orrer 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 ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
the case of "No Discharge,, reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YQU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED
"1 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 gather* PF the information, the Information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are Ificant penaltie r submi 'ng false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
(Date)
Additional copies of this form maybe downloaded at: http://portal.ncdenr ore/web/wQ/ws/su/npdesswtttab-4
S W U-250
lost revised October 25, 2012
Page 2 of 2