NCG080109 DMR SW

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wS Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted /VS/lila
CERTIFICATE OF COVERAGE NO. NI- Tata , SAMPLE COLLECT ON.YEA. 2.01(
FACILITY NAME CP,,AeLo .vo 4,0 T(WAR.1J •j,R.vadA16: SAMPLE PERIOD 9.i an-Jti`rre 1 July-Dec
COUNTY ° Ai, r.'14,r_,5a)/1,d,/3.! ° °' or q 'Monthly (month)
PERSON COLLECTING SAMPLES: /lilc,a,a ki,-PA—atekl,, DISCHARGING TO CLASS f ORW ❑HQW ❑Trout f PNA
LABORATORY3mt� ;, u � 4),xv�Y Lab Cert.# 1
R � REC _ (Zero-flow ❑Water Supply fSA
Comments on sample collection or analysis: � � � _ ®Other to
AUG 2 9 2016 PLEASE REMEMBER TO SIGN ON THE REVERSE 3
CENTRAL FILES- _
Part A:Vehicle Maintenance Areas'M'onitoring Requirements ' H DWR SECTION . l No discharge this period1
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Did this facility perform Vehici&Maintenance Activities using more than 55 gallons of new motor oil per month? V' yes _no
(if yes, report'your analytical results in the`table immediately-belows)-
Part B: Oil/water Separators and Secondary Containment Areas atPetroleum Bulk Stations and Terminals '
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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 0 '',r 25,2012
Page 1 of 2

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STORM EVENT CHARACTERISTICS:
- - Date SJR lita (first event sampled) '
Total Event Precipitation (inches): Z,7 '
-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�PARTA AND PART B MONITORING RESULTS: "-,;. ;*;
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION*B.
• • 2zEXCEEDANCES°INA ROW FOR`-THE SAME PARAMETER-AT THE-SAME OUTFALL?:-TRIGGER-TIER 2 REQUIREMENTS. SEE PERMIT PART IIISECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO 12
IF YES, HAVE:YOU CONTACTED THE-DWQ REGIONAL'dFFICE? 'YES ❑ NO❑
REGIONAOFFICE CONTACT NAME: '' ' - ..- ' - - '
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Mail an original and one cop,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"reportsrto: . - .... - ,
Division of Water Quality
Attn: DWQCentral,Files °s _
1617 Mail Service Center- f,°t ...,
Raleigh,.North Carolina 27,699=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'a't(on,the inforrnation'siiliMitted 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."
'' ' - 51 5 _
(Signature of�Permittee) " ° (Date)' ,
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4 ,,' ,. -.
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1 f SWU-250 last revised October 25,2012
( } Page 2 of 2