NCG080368_MONITORING INFO_20190110

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. I IV C& O � D3(o g
DOC TYPE 1 ❑ HISTORICAL FILE
fir MONITORING REPORTS
DOC DATE ❑ Ail DI I �
YYYYMMDD

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted 12/28/2018
CERTIFICATE OF COVERAGE NO. NCG080368 SAMPLE COLLECTION YEAR 2018
FACILITY NAME United Parcel Service - Chapel Hill SAMPLE PERIOD ❑Jan -June �X July -Dec
COUNTY Orange or F-]Monthlyl (month)
PERSON COLLECTING SAMPLES Ryan R. Osborne (INENCO, INC.
LABORATORY Pace Analytical Services, Inc. Lab Cert. # 12, 40, 37706, & 37712
LABORATORY INENCO, Inc. Lab Cert. # 5540
Comments on sample collection or analysis:
D15CHARGING TO CLASS ❑ORW F]HQW Trout [—]PNA
RECDEIVED
BAN 10 Z019
CENTRINL FILES
GVVR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
Zero -flow F_x ]WaterSupplyEISA
OOther WS-V; NSW
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
x yes no
1-1 No discharge this period ?z
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/I
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
-
SDO-001
10/26/2018
18.3
7.91
< 5.0
62
SDO-002
10/26/2018
16.4
7.41
< 5.0
62
SDO-003
10/26/2018
24.0
7.17
< 5.0
62
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/I
pH, `
Standard units
Permit Limit
-
15
50 or 100 see permit
Within 6.0 — 9.0
I 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
Page Iof2

STORM EVENT CHARACTERISTICS:
Date 10/26/2018 (first event sampled)
Total Event Precipitation (inches): 2.20
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 PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART It 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 0 NO IF XT
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F7 NO
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including oll "No Discharge" reports, within 30 days of receipt of the lab results for 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
Additional copies of this form may be downloaded at:
l -LA -19
(Date)
htt2lZportal.ncdenr.or&Lweb/wg/ws/su/npdessw#tab-4
last revised April 11, 2013
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year 2018
Certificate of Coverage (COC) No. NCGO80368
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: United Parcel Service - Chapel Hill
County: Orange K k . �%
Phone Number: 919-790-7474 .... Xotal no. of SDOs monitored:
Outfall No. SDO-001 CENTRAL FILES
Is this outfall currently in Tier 2 (monitored monthly)? DOM SECTION
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes �
Yes
Yes QX
No ❑X
No ❑X
No
Total
Rainfall,
Inches
Parameters, (units)
Total Suspended Solids,
(mg/L)
pH, {Standard Units)
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), (mg/L)
Benchmark
N/A
50 or 100 see permit
Within 6.0 — 9.0
15
Date Sample
Collected
01/28/Z018
0.71
10.8
7.72
< 5.0
10/26/2018
2.20
18.3
7.91
< 5.0
Outfall No. SDO-002
Is this outfall currently in Tier 2 (monitored monthly)? Yes No �X
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes No UK
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency
Received approval from DWQ to reduce monitoring frequency ❑
Other
Was this SDO monitored because of vehicle maintenance activities? Yes 0 No
Total
Rainfall,
Inches
Parameters, (units)
Total Suspended Solids,
(mg/L)
pH, (Standard Units)
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), (mg/L)
Benchmark
N/A
50 or 100 see permit
Within 6.0 — 9.0
15
Date Sample
Collected
01/28/2018
0.71
10.6
7.62
< 5.0
10/26/2018
2.20
16.4
7.41
< 5.0
United Parcel Service -Chapel Hill SWU-264-Generic Annual DMR
Last revised 5/17/2013

Outfall No. SDO-003
Is this outfall currently in Tier 2 (monitored monthly)? Yes No 0
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes 7 No �X
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQto reduce monitoring frequency
Other 71
Was this SDO monitored because of vehicle maintenance activities? Yes �X No
Total
Rainfall,
inches
Parameters, (units)
Total Suspended Solids,
(mg/L)
pH, (Standard Units}
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), (mg/L)
Benchmark
N/A
50 or 100 see permit
Within 6.0 — 9.0
15
Date Sample
Collected
01/28/2018
0.71
16.6
7.42
< 5.0
10/26/2018
2.20
24.0
7.17
< 5.0
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes 0 No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency
Received approval from DWQto reduce monitoring frequency
Other El
Was this SDO monitored because of vehicle maintenance activities? Yes No
Total
Rainfall,
inches
Parameters, (units)
Total Suspended Solids,
(mg/0Method
pH, (Standard Units)
Non -Polar Oil and Grease/TPH EPA
1664 (SGT-HEM), (mg/L)
Benchmark
N/A
50 or 100 see permit
Within 6.0 — 9.0
1s
Date Sample
Collected
"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: (A(,f 4 t / &Ak___, Date: 1 r `1 — 19
For questions, contact your local Regional Office
United Parcel Service- Chapel Hill SWU-264-Generic Annual DMR
Last revised 5/17/2013

August 22, 2018
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699 - 1617
QU6 2 8 201e
CGNTr�AL
�t
° Rs. r10N
Re: Stormwater Discharge Outfall Monitoring Report (DMR): Year 6, Period 1, Sample 11 - 2018
United Parcel Service — Chapel Hill
7411 Rex Drive, Chapel Hill, North Carolina (Orange County)
General Permit NCG080000; Certificate of Coverage No. NCG080368.
Dear Stormwater Permitting Unit;
We respectfully submit the enclosed original and one copy of the Stormwater Discharge Outfall
Monitoring Report for the United Parcel Service — Chapel Hill under General Permit Number
NCG080000, Certificate of Coverage No. NCG080368. This submission is for stormwater discharge
sampling during Year 6, Period 1, Sample Number 1 I (January -- July, 2018) as outlined in Part 1I,
Section B of our stormwater discharge permit. We are happy to report that all sample analytical results
were below benchmark values and/or within the benchmark ranges.
If you have any questions or comments regarding this Stormwater Discharge Outfall Monitoring
Report (DMR), please contact us at your convenience.
Sincerely,
Vincent Mollo
District Environmental Coordinator
United Parcel Service, Inc.
Enclosures: Stormwater Discharge Outfall Monitoring Report (DMR), 1 original & 1 copy

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted 07/08/2018
CERTIFICATE OF COVERAGE NO. NCGO80368 SAMPLE COLLECTION YEAR 2018
FACILITY NAME United Parcel Service - Chapel Hill SAMPLE PERIOD �X Jan -June D July -Dec
COUNTY Orange or ❑Monthly' (month)
PERSON COLLECTING SAMPLES Ryan R. Osborne (INENCO, INC.)
LABORATORY Pace Analytical Services, Inc. Lab Cert. 4 12, 40, 37706, & 37712
LABORATORY INENCO, Inc. Lab Cert. 4 5540
Comments on sample collection or analysis:
DISCHARGING TO CLASS ❑ORW DHQW Trout F_]PNA
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor ail per month?
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
Zero -flow EX Water Supply EISA
Other WS-V; NSW
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
X yes no
No discharge this period ?2
Outfal I
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/I
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
1s
-
5DO-001
01/28/2018
10.8
7.72
< 5.0
62
SDO-002
01/28/2018
10.6
7.61
< 5.0
62
SDO-003
01/28/2018
16.6
7.42
< 5.0
62
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
005S6
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids
mg/I
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
Within 6.0-9.0
i
t I 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
Page 1 of 2
t
ti

STORM EVENT CHARACTERISTICS:
Date 01/28/2018 (first event sampled)
Total Event Precipitation (inches): 0.71
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 PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCFFDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES 0 NO FX
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F--] NO
REGIONAL OFFICE CONTACT NAME:
Mail an original and one tape of this DMR including a!1 "No Discharge" reports, within 30 days of receip__t 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."
7lso!8
— 6f&� M�� (Signature of mittee) (Date)
Additional copies of this form may be downloaded at:
http://Portal.ncdenr.org/web/wg/ws/su/npdessw#tab-4
SWU-250
last revised Apri,*11, 2013
Page 2 of 2

January 8, 2018
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699 - 1617
JAN 10 Z01,8
INFO�MAN D*R SECTION
PROCESSING UNIT
Re: Stormwater Discharge Outfall Monitoring Report (DMR): Year 5, Period 2. Sample 10 - 2017
United Parcel Service — Chapel Hill
7411 Rex Drive, Chapel Hill, North Carolina (Orange County)
General Permit NCG080000; Certificate of Coverage No. NCG080368.
Dear Stormwater Permitting Unit;
We respectfully submit the enclosed original and one copy of the Stormwater Discharge OutfalI
Monitoring Report for the United Parcel Service — Chapel Hill under General Permit Number
NCGO80000, Certificate of Coverage No. NCG080368. This submission is for stormwater discharge
sampling during Year 5, Period 2, Sample Number 10 (July — December, 2017) as outlined in Part 11,
Section I3 of our stormwater discharge permit. We are happy to report that all sample analytical results
were below benchmark values and/or within the benchmark ranges.
If you have any questions or comments regarding this Stormwater Discharge Outfall Monitoring
Report (DMR), please contact us at your convenience.
Si cerel
7 41W /�/
Vincent Mollo
District Environmental Coordinator
United Parcel Service, Inc.
Enclosures: Stormwater Discharge Outfall Monitoring Report (DMR), I original & 1 copy

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 11/15/2017
CERTIFICATE OF COVERAGE NO. NCGO80368
FACILITY NAME United Parcel Service -Chapel Hill
COUNTY Orange
PERSON COLLECTING SAMPLES James W. Willard II (INENCO, INC.)
LABORATORY Pace Analytical Services, Inc. lab Cert. # 12, 40, 37706, & 37712
LABORATORY INENCO, Inc. Lab Cert. # 5540
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD ❑Jan -June [X July -Dec
orMonthly' (month)
DISCHARGING TO CLASS ❑ORW DHQW Trout [_]PNA
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A: Vehicle Maintenance Areas Monitoring Requirements (if applicable)
Zero -flaw 5]WaterSupply OSA
E-flOther W5-V; NSW
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
X yes no
No discharge this period? 2
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/I
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
SDO-001
10/16/2017
9.8
7.53
< 5.0
70
SDO 002
10/16/2017
4.5
7.34
< 5.0
70
SDO-003
10/16/2017
20.1
7.84
< 5.0
70
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
D0530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids
mg/I
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
Within 6.0 — 9.0
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
Page 1 of 2

United Parcel Service - Chapel Hill
r STORM EVENT CHARACTERISTICS:
Date 10/16/2017 (first event sampled)
Total Event Precipitation (inches): 0.16
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 2, 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 fl SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART li SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES F--j NO rX
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES r1 NO
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, includina all "No Discharge" reports, within 30 days of receipt of the lob results for 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."
12- }7
(signature of Urmitteel (Date}
Additional copies of this form may be downloaded at: hit ortal.ncdenr.or web w ws sun dessw#tab-4
SWU-250
last revised April 11, 2013
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted 06/14/2017
CERTIFICATE OF COVERAGE NO. NCGO80368 SAMPLE COLLECTION YEAR 2017
FACILITY NAME United Parcel Service - Chapel Hili SAMPLE PERIOD OJan-June ❑ July -Dec
COUNTY Orange or ❑Monthly' (month)
PERSON COLLECTING SAMPLES Ryan R. Osborne (INENCD, INC.)
LABORATORY Pace Analytical Services, Inc. Lab Cert. # 12, 40, 37706, & 37712
LABORATORY INENCD, Inc. Lab Cert. # 5540
Comments on sample collection or analysis:
DISCHARGING TO CLASS F_jORW F]HClW DTrout [:]PNA
RECEIVED
CENTRAL FILES
DVVR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?
Part A: Vehicle Maintenance Areas Monitoring Requirements (if applicable)
[:]Zero -flow �X Water Supply OSA
FX Other WS-V; NSW
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
X yes no
No discharge this period? Z
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/I
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
-
5DO-001
05/21/2017
8.8
6.77
< 5.0
70
SDO-002
05/21/2017
25.0
7.44
< 5.0
70
SDO-003
05/21/2017
30.8
7.57
< 5.0
70
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals {if applicable)
outfali
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
0040D
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids
mg/I
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
Within 6.0 — 9.0
i 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
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 05/21/2017 to 05/22/2017 (first event sampled)
Total Event Precipitation (inches): 0.71
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 1, 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 It SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES NO r
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES NO a
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 for 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)
Additional copies of this form may be downloaded at:
6LI?4?Zl
(Date)
http://PoTtal.ncdenr.org/web/wg/WS/SU/ni)dessw#tab-4
5W U-250
last revised April 11, 2013
Page 2 of 2