NCG080109 DMR SW (3)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted $12S/i kt
CERTIFICATE OF COVERAGE NO. NC( = cl--:' SAMPLE COLLECTION YEAR 2-0i
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FACILITY NAME �:I�I�'Loz& CeA76-4t----F .' Ru�iG,�.uC.��
SAMPLE PERIOD
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PERSON COLLECTING SAMPLES' AU KIA,Am KikP/4-ntrAc.+, DISCHARGING TO CLASS ❑ORW I IHQW ❑Trout ❑PNA
LABORATORY 5IAEALS 55jv�P,�,, n� jrtLab Cert.# c:g�'r�S ❑Zero-flow (Water Supply PISA
Comments on sample collection or analysis: _ .. ®Other ea 0,5„, C..
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
.. ' AUG 2-9 2016 "
Part A:Vehicle Maintenance Areas Monitoring Requirements ` No discharge this period
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Did this facility perform VehicfeVaintenance Activities using more than 55 gallons of new motor oil per month?k yes _no
(if yes, rep6rf your analytical results in the''table ir'nrnediately below)1' ,
Part B: Oil/water Separators and:Secondary Containment Areas at'Petroleu°rim BulkSttions and Terrriinafs ."'
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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

STORM EVENT CHARACTERISTICS:
- - Date-506//4 (first event sampled)
Total Event Precipitation(inches): ''IS
-Date - - (list each additional-event-sampled this reporting period;and rainfall amount) - . .
' Total Event Precipitation (inches):
Note: If you report asamp'le'"value in excess of the benchmark,you Must implement Tier 2, Tier 2, or Tier 3'responses. See General Permit text: .
FOR.PARTAAND PART B MONITORING RESULTS: :; _ �� �+ , , • ; r
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• • 2 EXCEEDANCESINA ROW•FOR`-THE•SAME PARAMETER AT THE SAME OUTFALLTRIGGER,TIER ZREQUIREMENTS. 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 I[]NO.X
IF YES, HAVE'YOU'CONTAttED THE-DWC REGIONAL FFICE? `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,Cen'tral Files , °,J - ' . . ro £.-,°€ e ,� _
1617'Mail Service Center- v;i,..-,;, = __ -
Raleigh,,North Carolina 27.699461,7 r • , ,
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YOU MUST SIGN_THIS CERTIFICATION FOR,ANY INFORMATION REPORTED: �•.a '� .
"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 responsiblefor`gathering`the'inforniati'o`n,the information su'bniitted is,to the best of my knowledge and belief,true,accurate, and complete: Iain aware that
there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
"..-- . *, ifto,\,.‘ - ,.: - - . 5:5/zSiii3 ,
(Signatur- • Permittee) �'
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Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4, , , , - --
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SWU' 50 - last revised October 25,2012
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