NCG080762 DMR SW

C 4d
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO8OOOO
Date submitted January 19, 2016
2015
CERTIFICATE OF COVERAGE NOW ' '� SAMPLE COLLECTION YEAR
FACILITY NAME North Carolina & Virginia RR SAMPLE PERIOD ❑ Jan -June July -Dec
COUNTY Hertford or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES William Ross DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY TestAmerica Lab Cert. # 269 RECEI'V'E[) ❑Zero -flow ❑Water supply OSA
Comments on sample collection or analysis: ❑Other
Sampled Holding Tank from Maintenance Pit JAN 21 2016
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of Rffln§Fd Fp� r month? �_ yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this periods
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT -HEM), mg/L
Total Suspended
Solids, mg/L
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
-
002/003
12/28/2015
7.8
8.27
1.9
295
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
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT -HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0-9.0
1 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
Pagel of 2

STORM EVENT CHARACTERISTICS:
Date * NA (first event sampled) "Sampled from holding tank
Total Event Precipitation (inches):
Date NA (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 INA 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:
Mail an oriainal and one coon 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)
1,-Zo- Zot S
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250
last revised April 11, 2013
Page 2 of 2