NCG080109 DMR SW (2)

0, Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted '7;`Vs i 1Ji
CERTIFICATE OF COVERAGE NO. NCGO8 Oj.Sl 3.. SAMPLE COLLECTION YEAR 2-CAL
FACILITY NAME CP,f Q4,a;'V Aka WL-it?s(4 AiLN " R./ C,P„s6-\) SAMPLE PERIOD ®Jan-June July-Dec
COUNTY J67e•C"�Ny .,,,rt,Y,,, s -" ,- r , ° . 5 " ', or_,:„ Monthly (month)
PERSON COLLECTING SAMPLES, /hi Z►aoari... iCok.PATIrt.tei.., DISCHARGING TO CLASS _ORW f HQW (Trout f PNA
LABORATORY s1 &1t. E . f) tu, La _ _ __ ./_� _ __ ._,
Comments on sample`collection or analysis: ` ®Other [•Irt. s.
t PLEASE REMEMBER TO SIGN ON THE REVERSE -
;
Part A:Vehicle Maintenanc6'Ai'eas'Mon'itoring Requirements '
IS ' '` `' j I'No discharge this period-1
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Did this facility perform VehicieiMaintenance Activities using more than 55 gallons of new motor oil per month? VI yes _no
(if yes, report your analytical results in the'table immediately below), " '
•
Part B: Oil/water Separator's and SecondaryContainment Areas at-Petroleum BulkStations 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 er 25,2012
Page 1 of 2

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STORM EVENT CHARACTERISTICS:
Date. 51:3/lL (-first event sampled)
Total Event Precipitation (inches): 2,7-
.
Date (list each additional event sampled this reporting period,and rainfall-amount) -
Total Event Precipitation (inches): •
a _ .. .. . .
' Note: If you re'port'a sample.;value.'in'excess of the benchrnai'k;you'in'ust implement Tier-1, Tier 2, or Tier3 responses. See General Permit text.
.. ''-',0.;%"
FORxPART_�A AND PART B MONI=TORING RESULTS: ={WL ��; �' ,, ,,r .
a . I ;P",,
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION'B. '
• , 2'EXCEEDANCESSINA ROW-FORTHE SAME'PARAMETER.ATTHE SAME OUT'FALLTRIGGER 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 n NO 12
IF YES, HAVE'YOLI 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 U V . . i' ,`}' , ,:.'— : ;; c
1617 Mail Service Center- ,,; "g� , ,'
Raleigj),,North Carolina,27,69971617 , ; s• V.
4 CI t
YOU MUST SIGN_THIS.CERTIFICATION F.ORANY INrORMATION REPORTER:. ';M -- _
-
"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'gafhering the'infdrma'tion,theinfOi'M'aildili silhtnitted is,to the best of my knowledge and belief,true, accurate, and complete: I aYn aware that
there are significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
-_ _ .. _ -._..- ._ r'K i
• "Za 3l 2S/lio , , - .
(Signature of'Permittee) (Date) ,
' . 4 i.. ,
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdess-w#tab-42,,-' ,. , , r
' ' :2 " , • a r `1 1:"-- • a r ` r S.2 t a " i.'"4 c - , `_ ;A'. •r s " I
sV `�i• - �, . -
,' ySWU-250 last revised October 25,2012
i Page 2 of 2