NCG080582 DMR SW

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted
CERTIFICATE OF COVERAGE NO.
FACILITYNAME
COUNTY SL-ia,,eA I ff
PERSON COLLECTING SAMPLES IM �kQ &Q_
LABORATORY tAjt ryh&(, Lab Cert. # I I
C/JQ1m� ments on sample collection or analysis:
`-
I 51 MI�1eS W-4-6 jjg - CO l eeC fL( . �l�YneP,- 1 S D�X��
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR Z 20)S_
SAMPLE PERIODJan-June [A July -Dec
or Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
RECEIVED
C�,Other &1:
JAN 2 1 2016 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
C NTR L FILES ❑ No d►schorge this period'
DWR SECTION
Outfall Date
No. 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
-
N4-ir,rlPe-kd
01 r� _ � U 15,
� S. o
L /,00
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? -Ayes _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 Date
No. 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
0014
5,
5',2a
N4-ir,rlPe-kd
01 r� _ � U 15,
� S. o
L /,00
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 1 of 2

STORM EVENT CHARACTERISTICS:
Date ��Z ''(first event sampled)
Total Event Precipitation (inches):y'
Date 1015'// (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches): d • 1� )`YI
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 AAND 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 -
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, un er 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 ersonnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly fespo sable 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 sig 'ficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
of Permittee)
I 6
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S WU-250
last revised October 25, 2012
Page 2 of 2