NCG080201_MONITORING INFO_20190205

STORMWATER DIVISION CC
NCG PERMITS
PERMIT NO. 1VC&0FO30'
DOC TYPE 1 1-1 HISTORICAL FILE
CYMONITORING REP
DOC DATE
VYYYMMDD

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No NCG080000
Date submitted "APA, w�
CERTIFICATE OF COVERAGE NO NCGO8 o -r- a- t SAMPLE COLLECI ION YEAR -La,.s
FACILITY NAME A c.g riytq t�ahC� CaMP�a� SAMPLE PERIOD ❑ Jan -June July -Dec
COUNTY it."-tn or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES Boa 'N k n DISCHARGING TO CLASS ❑ORW ❑HQW [:]Trout ❑PNA
LABORATORY � ,r3 J� Lab Cert # Icy _ EIV E � ero-flow [:]WaterSupply [:]SA
Comments on sample collection or analysis FEB 0 5 2019 Rother e *6t, C"
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? �es ®no (ifyes, complete Part A)
Part A Vehicle & Equipment Maintenance Areas Monitoring Requirements (If applicable) [ �odischcirge this penodz
Outfall No
',Date Sample Collected'
(mo/dd/yr)-
24 hour rainfall amount,
Inches3
Non -Polar Oil & Grease
mg/L
Total Suspended Solids,
mg/L -
New Motor or Hydraulic Oil Usage,
gal/mon _
Benchmarks
-
-
1s
100 or 504
-
Parameter Code
-
46529
00552
C0530
NCO I L
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedanc e for the same parameter at the same outfall
z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here
'The total precipitation must be recorded using data from an on -site rain gauge Unattended sites may be eligible for a waiver of the rain gauge requirement
4 See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Note Results must be reported in numerical format For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format When results are below the applicable limits, they must be reported in the format, "<X,L m L" where XX is the numerical value of the
detection limit, reporting limit, etc in mg/L Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX"
Permit Date 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Page 1 of 2

!'t 0- .
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable) 16o discharge this pertod2
Outfall
2.4
No - _
Date Sample
Collected)
�(mo/dd/yr);-
24 hour rainfall
amount,
s Inches'
Sample Collected;
mo/dd/yr"
r - -
Total Suspended
- Solids,
r -�mg%L
pH, y
Standard units
Non -Polar -Oil &
`"Grease,' 1
s. +
s100or50"
60-90" :
15 -'
46529 #
- `;
"-COS30`_
00400 =�
_" 00552
Footnotes from Part A also apply to this Part B
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 PARTS MONITORING RESULTS
• A BENCHMARK EXCEEDANCE 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 II SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ®NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ® NO
REGIONAL OFFICE CONTACT NAME
Mail an original copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the jab. results (or at end of monitoring period in the
case of "No Discharge" reports) to
Division of Water Quality
Ann 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
Date
Permit Date 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCGO80000
CERTIFICATE OF COVERAGE NO NCGO8 n -z- o �
FACILITY NAME HCu,��s?off
COUNTY i'6�zF,
PERSON COLLECTING SAMPLES
LABORATORY
Date submitted a I. f
1
Lab Cert # ---
Comments on sample collection or analysis
Part A Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION AR
SAMPLE PERIOD tan -June ❑ July -Dec
or ❑ Monthly) (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ]Trout OPNA
RECEIVED ❑Zero -flow []Water Supply ❑SA
JUL 2 0 2018 [:]Other
CEN nh >_ FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
r,f °P SECTION
No discharge this period'
}r i �
fall
sy�a r � �� w�..
�k="r ;
. rF r,
ryry�1r Fv—� y � a -.s6
'n ti'�y l l l�,h) 1F .�'
_ „tea 00530 4
k. K 1}K z •�, I
{j' ,
_ .00400
r 7 ' e s Y '� �[ J
f � } r �r4�� , 1
-
r_bate
rr `r{ �y-�rt}�..r'�
r�Sample Collected;`�`s
s��,1T �^,� T� -.� �,...
•�-Total�Suspended 2 4
- �r�i '"1 r 1� � ti _ �
-- � pH;,;��
ram` 1 vs '" -,e
= ,Nan-Polar-0rl a td'Grease%TPH &A
�P -- � r°'-�,xa
r= New Motor Ott Usage,?r„
vtr i %tom yn
5s` r�a:7-7 s- '
7 �S n M = '-4Y
a y,
r�'�'��;rMett�od
ate= r5 yrr4c a^ 7 K(
1664 5GT-Hl`M)';mg/L=
.. _i•;M c+."
Annual
,_NStanclardaunits--"
ws
average gal/,mop
Benchmarks
�� � `, � r
4fssb,z or 100 ses,perrnii
6 0 — 9 0
s
E� � t
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? `yes _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
= r' Outfall _ `£
4NO", . ,
_L n�*Date vrt s`{"
`Sample Collected,;
'
^ 'r h F _ y 00556, ��? ' [ 1 LT 4
4 ` !9y a~r1 } VV JJO ` ` r
00YU0� [2 l t J
xNon-molar Oil,and Grease%'KPH EPA,Methotl, ^
r1664 (SCAT -HEM)), qg/L
' jotal Suspended Solids, s
x1 ° �' lip mg/L
_ _ _ v pH,_'y
[Standard wits t
Permit Limit
-� ° '`
- zC - f i5 - -
5d or`100 see permit
6 0-94M
t For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here
S WU-250
last revised October 25, 2012
Pagc I of 2

STORM EVENT CHARACTERISTICS
Date a6 - - (first event sampled)
Total Event Precipitation (inches)
Date s _ (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 II SECTION 8
• 2 EXCEEDANCES 1N A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIPEMENTS SEE PERMIT PART 11 SECTIONS
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
1F 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 lob 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 "
(Signature
❑� Il (O
(Date)
Additional copies of this form maybe downloaded at http //portal ncdenr org/web/wq/ws/su/npdessw#tab-4
SW U-250
last ievised October 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCGO80000
Date submittedl�t,
CERTIFICATE OF COVERAGE NO NCG08�„ T SAMPLE COLLECTION YEAR zA»
FACILITY NAME r1 .� SAMPLE PERIOD 0 Jan -June ❑ July -Dec
COUNTY Ga�*��;+k — RECEIVED or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout [:]PNA
LABORATORY y tab Cert # — AUG 0 S 2017 ❑zero -#low [—]water supply ❑SA
Comments on sample collection or analysis CENTRAL FILES ❑Other
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A Vehicle Maintenance Areas Monitoring Requirements P No discharge this period'
s
1� Outfally ,`-
�f w � r �
r +,�NoA �
y�y, ��•, �a,`!
F'j..[S�a _ ]^ "�ti �v � r�
. -,' �t,Date;,.F�
1 T
,-Sample Collected,
r r >�
.�fma dd_ yr R
l� G H �—{�— y. 1�z
q-� s t D058D„� �� ,
�
^S IN-- / 1' l
�;' ;� <OD400 ';�s,
i4. _ I _
}� ��� 005B6F s� t 4 v ; =,
— _
' a.4 - �_�{-�' -+
�}` n t l
I Total Sus"pendedT
.�_;:�SolldS,`mg/Lr1 ;
„ s. �' i �' , r
R ;� pFi,.f- 4
-
rM 1_.; Standard units-
' '� � a ' r , �
trNon-Polar Oil and Grease/TPH EPA ,
r'-t b 7r4 T �, _-F
„ 4Metfiod�1664 �SGT-HEM); mg/L, �,
} 1�•.. a
New Motor 01I Usages .l
t -+.1 �2 - yLEi .-
Annual averagetgal/mo,-
18eiic niiar'k-:
tit9 ` t x`:l,A), �'ry' 4 -` n
�560r i0 6 see permit
' j-WEfiiln,6'9 ``,9 Q' ,�'
-�'" §'� ,�` wr � '15 x" `"; , -
� � fw,y »- ,� � = r w
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?,— yes _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
Outfal!
.s 'Date,
=_iJ.". �r s ��x , 005SG, •' J
F 00530-
00400'
No' ,, ,
i, Sample Collected,,
Non -Polar OBI and E
GeseTf.
TotalSuspented Solids,
H,a*
`
_�mo/dd/yrr ;V
y,M,ethod
S' �`1664 (SGT-HEM ;mg
mg/L _
Standard Whits
.,
Permit Limit
- = " t
-< < '� ,n 15-j;
°' S0 or 1aD see 'ermit
6 b = 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 October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS
Date L% _ (first event sampled)
Total Event precipitation (inches) _
Date _ �i.:k _ (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 If SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART Ii SECTIONS
+ TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL7 YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES []NOFJ
REGIONAL OFFICE CONTACT NAME
Mail on original and one copy of this AMR, including all "No Discharge" reports, within 30 days of receipt of the lab results or at end oonitanng period m
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
t"Lr }ll
([late)
Additional copies of this form may be downloaded at http //portal ncdenr orgiNwebjwgLwslsu/npdessw#tab-4
SWU-250
last revised Octobei 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCG080000
Date submitted
CERTIFICATE OF COVERAGE NO NCG08
FACILITY NAME .'6&b
COUNTY- - �4�2— _
PERSON COLLECTING SAMPLES
LABORATORY_ M�� �� aa_ � _ Lab Cert # NuF
Comments on sample collection or analysis
Part A Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR —L l
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
Other G
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
�/D ❑ Na discharge this period'
AUG 08 2017
" Outfall
i �r.i t � 1
No .Y ��
V 1i'�i4y���>
;' �``=ram �r s'
Date
y i 1 K ,f �h i is
Sample�Collected,
r' J .. �r �i ��n �"' Fk '� h?
'��mo d"d r'r R
/Y r
`0(#400.^C
MA imr
�� 3.. ry , + ♦�� -r .,
r, � Total Suspended n
w � i�l
�S �` -
t s.r , 811d5rFmg/Ls a ,
a.i {�_ +sy � . ,
„ „� ,x pH,�,- �[,
`9 h`s�
c_ y F'�rRMethod`168;4
a a Standard units
M
� H' 1
�a r � pr( Oil and Grease/TPH EPA
V
5GT-HEM x rri L-
{ _ , g/
l/ i 'f 'x
r Nevi Motor 0i 1 Usage, - ;
Annual averse al mo �
gn 1R /
� u ' ]
fWdncfi'nark�
=�74� �,-' 4 ,r
v i ;`�� '1 ){ �.� )
r' "�. � � rl3l�F� r
�50 or 1Q0 see permit :
y4 h �� �
=,~Withln,6 0, ,_S�0 .�,
�1��
xti ,� L
to
1a
�5W ILI
�I
l
Did this facility perform Vehicle Maintenance Ac-wities using more than 55 gallons of new motor oil per month? _✓yes _no
(if yes, report your analytical results in the table °mmediately below)
Part B Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
��Dutfall
ti� 1 2r a
A t ;Date [
a
Sample Collected -
��p_
� v/dd/yr �? N
r �• - '"L .. r~ , y + ± r , 5 r `1
r , ` ,- { 'r 0q"S56 , _
-- *
�,,00530,, _
ry ;
w 0040e,4 ,
't er a
Non -Polar Oi!)ano Grease/TPH EPA MetFiod _
� 7 . - �µ
`ter' `'F� r s f1664 {5t5T;HEM); mg/Lt , _ Y
rr[ +
- ; x Tatai Suspended Solids
i �� + t
, „ _ � mglL
s {.
Standard Units t�
_
Permit Limit
,� K ti { xr ; '
- a' �j ' ` '{ 15 °+ r °��
r 7 a
50 OC 100 seespermit
+ 6 0 —90 --ti
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 4 , k (first event sampled)
Total Event Precipitation (Inches) i
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 11 SECTION 6
+ 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 ANYONE OUTFALL7 YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME
Marl_ an original and one copy of this DMR including all "No Discharge" reports, within 30 days of receipt of the lob 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 inquiryof 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"
(Signatu
e
(Date)
Additional copies of this form may be downloaded at http //portal ncdenr org/web/wq/ws/su/npdessw##tab-4
S W U-250
last revised October 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCG080000
Date submitted 1�,4
CERTIFICATE OF COVERAGE NO NCG08 0 -L � ,
FACILITY NAME ccM�
COUNTY
PERSON COLLECTING SAMPLES
LABORATORY nL-a : e Lab Cert #
Comments on sample collection or analysis
Part A Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR zote
SAMPLE PERIOD ❑ Jan -June �]( July -Dec
or ] Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEIVE® ❑Zero -flow ❑Water Supply ❑SA
©Other" c ' _
SEP 2 � 2ll Ib
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION '
No discharge this period
Outfail,s
�� No
4 lyF
vS Dater mot,
'sample Collected,
]x p^il ri'tF'7}.`^•�S-
w Imo/dd/yr;�Salids;
, �, h t r
r
4 C
00�56
es,e'�.{'
1 Total Suspended F
ii Jri' S.i^�.+ "-- _>`�
mg/L _
2..-
f� ;�° pFi ';
T- ! �4t J.v�'ir i.'f-aF.c
�xs Standar_d,units�,
f� r x ,Y �-t�
� l'W � ve' Ad,
'" Noii-Polar Oil and Grease/,TPA EPA`
�er`� J T•'� ".�'T+�i--'r F i _ 1-
,� M_ ethod 16fi4 �SGT-HEM), mg/L�
� J -�� r 1 i"-.•5 .r ..
fWWMoGr'- 'Oil, sage �
•, RI
Annua[ average gel/mod
.,�,�Al"
Benchmark r
; — r "T t`� y
L � �<�
' ar , �nrd..s m rsrs ,
-50 or 100 see,permitf
fn t d r v r ic,. 4
�f�: Wit&n 6 0 -�_9 01y­4
ik,�
i
y
f6 Mfa L-
7 o
t 5 tnc
10 r ntk--
-cl
a�5laijiu L snafu. -�o t5r�c�lti—
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _✓yes _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
r - r* *�' ` +✓_,�Or�;.`<7,ui Yt3�antf � +r-ndT1[
Cledp�
a,t
mo/dd/yrT„
= ' r�f;'-rt
�
,., 0040� f
0�
aiTs,
Mihod-*�-
rOane Le
`Z; ;'Total Suspended SolidsI
t t M-
_in�,
H=Sameaecl r viKty
tt-
ACb}
Standard u-
Permit}Limit'-
,�; _r r
� 5, ;�, `'15�. 1 r ` �,� - -
L 50 or 106 see permit , -
�; t 6 0 ,9 D :r�
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 October 25, 2012
Page I of 2

STORM EVENT CHARACTERISTICS
Date 4 w 4 (first event sampled)
Total Event Precipitation (inches) ► 'Ito
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 ll 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 ANYONE 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" report within 30 days of recei t of the lab results or at end of monitoring eriod in
the case of "No Oi_schaMe" report
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 -nd 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
4-1
(Date)
Additional copies of this form may be downloaded at http /lportal ncdenr_org/web/wq/ws/su/npdessw#tab-4
SW U-250
last revised October 25, 2012
Page 2 of 2

i�
�C67ri �J�CEi1
HCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form please writ httn //portal ncde[jr ore/web/wq(ws/su jnpd0sw#tab_ 4
Permit No r�/�/r1/ v // 4 /�/ �, {p / or Certificate of Coverage No
Facility Name +Wcs - ,,, 70 ca4:;:NO.4 --
County F ,,rrr{ Phone No
Inspector s�o
Date of Inspection
Time of Inspection
Total Event Precipitation (inches) ►'I,o SEP 2 6 2016
Was this a "Representative Storm Event' or "Measureable Storm Eve n:% 1 pq4Lby4he permit)
(See information below) DWR SECTION
[-Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event' or "measureable storm event" (requirements vary, depending on the permit)
Qualitative monitoring requirements vary Most permits require qualitative Monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable
A "representative storm event' is a storm event that measures greater than 0 1 inches of rainfall
E and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0 1 inches has occurred A single storm event may contain up to 10 consecutive hours of no
precipitation
A 'measurable storm event" is a storm event that results in an actual discharge from the I
permuted site outfall The previous measurable storm Pven - must Pave been at least 72 hours
prior The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office I
By this signature, l certify that this report is accurate and complete to the best of my knowledge
Permittee or Designee)
Page 1 of 2
SWU 242 Last modified 10/25/2012

1 Outfall Description
Outfall No - -Z 31� =W Structure (pipe, ditch, etc) � - � --Z!c�qmbY Liz, --Zz , , z z.b floe
Receiving Stream S-'U' f-.Rx_
Describe the industrial activities that occur within the outfail drainage area
2 Color Describe the color of the discharge using basic colors (red, brown, blue, etc) and tint
(light, medium, dark) as descriptors
3 Odor Describe any distinct odors that the discharge may have (i e , smells strongly of oil,
weals chlorine odor, etc) y- na- �—
4 Clarity Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy �f
1` 2 3 4 5
5 Floating Solids Choose the number which best describes the amount of floating solids in
the stormwater discharge, where I is no solids and 5 is the surface covered with floating solids
1 2 3 4 5
6 Suspended Solids Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 )s extremely muddy
1 2 3 4 S
7 is there any foam in the stormwater discharge? Yes
8 Is there an oil sheen in the stormwater discharge? Yesi1
9 Is there evidence of erosion or deposit --on at the oatfall? Yes No ,
10 Other Obvious Indicators of Stormwater Pollution
List and describe
Note Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure These conditions warrant further investigation
Page 2 of 2
5VYU 242 Last modified 10/25/2012

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCG080000
d�-o(
CERTIFICATE OF COVERAGE NO NCGO8 . %
Date submitted U,\#,."
FACILITY NAME
COUNTY vaivsv
PERSON COLLECTING SAMPLES
LABORATORY — Lab Cert # —
Comments on sample collection or analysis
Part A Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR u�u
SAMPLE PERIOD alan-lone D July De. -
or ❑ Monthly' month
DISCHARGING TO CLASS ❑ORW E]HCtW []Trout ❑PNA
Zero -flow QWater supply ❑SA
RECEIVED ❑Other
JUL 18 20IG PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES [✓] No dlschorge this period'
DWR SECTION
Y
k Oug fai!
Date ,DO'0 �`
! � ��j�' M d s �r
Sampl Collet edy T tal Suspended
OOr00s�e
N,
qG }"
n �+pAnr
s ,Qy6
�nr ,oia,Qi and Gr a%TPH EPA
wk `` �
'. e
H •�'{" F
wdMoto�OiiUsage,i
� 3tua a,e�age, frrno {
R Ks .ter sr "
Benctirnar,
/y� f
AM�
Yq Y �4i�fm "n�`
SQ or 1D0 ee9 r !WWfthl
6 0 9=0
U
L /�
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes _no
(if yes, report your analytical results in the table immediately below)
Part B Oil/water Separators and Secondary Contdtnment Areas at Petroleum Bulk Stations and Terminals
' Outral�Date
No
S mp a Gall ed,t�n
u'�sw"$- !Qy" ;� C'�d rrPr�
ola Oi nd Grease/ 1H EPA MetjrodY KTM.11&�s""Wni,edSlids r 6r4 [5�M)g�L
a
Y`f'i '�'iH,"41A h"c y
tlPer�mitLfJnit
�
"w WON
N
1S
s �. a ;r r. �
'.
0 or Op a
,�� i� ,.,,,
I For sampling periods with no discharge at any single outfall,youu 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 (first event sampled)
Total Event Precipitation (Inches)
Date 4 (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 Z 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 ANYONE 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 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 "
{Sign ature(aW�mittee)
-11 al -
(Date)
Additional copies of this form may be downloaded at http //portal ncdenr org/web/wq/ws/su/npdessw4tab-4
S W U-250
last revised October 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCGO80000 �
Date submitted
CERTIFICATE OF COVERAGE NO NCG08 . , -
FACILITY NAME
(,ouNTY s��}
PERSON COLLECTING SAMPLES 11Ne 5.'e45
LABORATORY rti Lab Cert # +.S
Comments on sample collection or analysis
Part A Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR
SAMPLE PERIOD ❑ Jar-Ju^e u my-uec
(� �� �� fj — ark ❑ Monthly'
(month)
"�DISLHARG�i P 0 CLASS ❑ORW ❑HQW ❑Trout ❑€'NA
3
OCT 0 5 2015 ❑zero -flow ❑Water Supply E]SA
['Other_
CENTRAL FILES
DWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE �l
❑ No discharge this period'
�';"O`gufiall;F
Noy
ampl`eRCno tested Total S, spen ,ed
F,{
N Pal raa�l afn r ase7 TfP I EPq `.
�le'wslV(ato ArI Usa ems, '
id�s,'�/L
M�-thodb6�1SGFIIENit), gC
/nnua a�e_rag gai/�O
Sens aykffiro
M�� r a �sya �a
�OOaseepers�itr
�~
11,I1t�Q
a ,ram.
���5 a
�
��'�
ti
cfi+ w 1�
,w
'4J
Crn N.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oij per month? ✓yes _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
f�70utfa#I,
!Va
r� `ram a
i DatePon
`�a ' le Col'ected,
i mo/r�4lfy x
Falr.`Oi�-and Grease% 1 E�aA N�eha
EM')a Li?%
S sp nde-'Salids;�&NAN
-g/L
��
a da��dunits
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 rcvased October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS
Date �A,�ta (first event sampled)
Total Event Precipitation (inches)
Date (fist 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 Z or Tier 3 responses See General Permit text
FOR PART A AND PART B MONITORING RESULTS
6 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 ANYONE OUTFALL7 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 Dischar-ge" 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, 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 P e) (Date)
Additional copies of this form may be downloaded at htt ortal ncdenr orgLweb/wq/ws/su/npdessw#tab-4
SWU-250 last revised October 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCG080000I)PI, A>-Tn
o Xo I
CERTIFICATE OF COVERAGE NO NCG08 o - 4 I
FACILITY NAME tV6S r
COUNTY *UPS -
PERSON COLLECTING SAMPLES —
LABORATORY -- Lab Cert # —
Comments on sample collection or analysis
Date submitted a� L,14s Ic r
Part A Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR r� '
SAMPLE PERIOD ,:an-.1u.[e "July -Dec
or ❑ Monthly'. (month)
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
1 V — ❑Other
RECE
gG a 4 2a10LEASE REMEMBER TO SIG ON THE REVERSE -1
CENTRAL FILES No discharge this period'
DW R SECTION
�Ou'fall�.�
i.lected otaikSuspendeeiNo
� Jr �'WfqAM
�t�4'�
P far Od Grease/7g H E'p_AW9jYe
Y.Y.�41f
�fVi��tl?od I.tSG ' =.. , mgn
�'`' hrMa?-'�"°g'' a�' i1 iamplemi
SMoto Oil�iJsa
Benchmar
� `�
�fZb A'["s4'y� ��-
50 orfsl't�7 set pe�LrrtIt Within 6 — a�
l fas.Euh
"t
_ , x
would
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? "yes _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
�` `t0utf iE m g
�' r Nfo
` ��oci/,!
3Date L
5arr pl a ec#e
^ . 006
�,»�0u00
���p♦m;,�
'v'�' � V� � e'�4
Non -Polar Or n�G*,rea !PA Met yad
1'1 IiT3 ��k3D�{011,1111
EMStantla_,
��-. y'u� �' � ++i" 1'i'�ui1
,'To,' aI S"usp nded yo ds,
p v
*6'P�m�t LSE
w
;
A7 ry
5
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 October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS
Date 4. (first event sampled)
Total Event Precipitation (inches)
Date L (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches)
Note !f 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 II SECTION 3
• 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 ANYONE OUTFALLa YES ❑ NO Er
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Marl an original and one copy of this OMR, includlna all "No Discharge"' reports within 3D days of receipt of the lal; results or at end of monitoring period rn
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 1 am aware that
there are significant penalties for submitting false information, including the possibility of fines and ;mprisonment for knowing violations "
(Signature of
(Date]
Additional copies of this form may be downloaded at h,ttp I/portal ncdenr org/web/wq/ws/su/npdessw#tab-4
S W [J-250
last revised October 25, 2012
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCGO80000
Date submitted
CERTIFICATE OF COVERAGE No NCG08_,. -z�_ _,, _L
FACILITY NAME
COUNTY
PERSON COLLECTING SAMPLES
LABORATORY -- Lab Cert # V C I VC
Comments on sample collection or analysis FEB 0 5 2J15
CENTRAL FILES
DWR SECTION
Part A Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR
SA r1PLL rERIOD lJ jan-June E July -Dec
or ❑ Monthly' (month)
RIFC DISCHARGI G TO CLASS ❑ORW ❑HQW []Trout❑PNA
f, ❑Zero -flow ❑Water Supply ❑SA
2615 ❑Other
DK/
CE 5FL r1Lir
C1-JL. `13 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
[" j wa discharge this period'
Outfallf Date
No Sample Collected, To151,S
a mo%dd/yr,. Sof
{�Ff,� Igo-Po{ar, OEland Grease/TP,HEPA
Standarid,units Method 1�664 {S,<irTEM ring/L
.., �.
New MotorOIt Usage,
nnuaf average�ga[%m_o
yea 23uxs s t y w wn r
Benchmark ION rr- O see`pp it]XINKI
u v' �
,N26
�+ r
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Zyes _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
JMOM�
ar
bater
Sample Collected;
mo% d/,yrr
..,k
"`M."'SC "'4' �1"' 1�
:.i-.t$•;IHs%`�7 �etfh'%Md
Non -Polar Oil and Grease%iif'H ETataiSuspended Solsds,
1G6, (SGT g �), mg l;mg%!
Y.Y"'j rt
= .. pH,
Standard units ;
Pe mit L mit
SRI tom 91a
�`5 � M 9 WA 4 DSO or SOti see Rr it.
6 O' g
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 I of 2

STORM EVENT CHARACTERISTICS
Date a!}.,_ (first event sampled)
Total Event Precipitation (Inches)
Datei_ (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 II 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 ATANY ONE OUTFALL? YES 0 NO Q/
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mail an original and one copy of this AMR including all "No Discharge" reports within 30 days of receipt of the Jab results (or at end of monitoring period in
the case of "No Discharae" 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 infor nation, Including the possibility of fines and imprisonment for knowing violations "
(Sig
4,14t,h2
(Date) ,
Additional copies of this form may be downloaded at http //portal ncdenr orR/web/wq/ws/slnpdessw#tab-4
S WU-250 last revised October 25, 2012
Page 2 of 2

CERTIFICATE OF COVERAGE NO NCG08 0 a ti
FACILi l T NAME _ RFC , rn�etui3
COUNTY
PERSON COLLECTING SAMPLES 5 'EA-nais
LABORATORY t'—LT* Lab Cert # +�S
Comments on sample collection or analysis
Part A Vehicle Maintenance Areas Monitoring Requirements
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No NCG080000
Date submitted ow. d
CEI'd I "L FILES
SAMPLE COLLECTION YEAR -r.atq DW018GG
SAMPLE PERIOD Jan -June ❑ July -Dec
or ❑ monthly' month
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
[]Zero -flow ❑Water Supply ❑SA
QOther '-!`
RECEIVED
JUN 12 2014
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
No dtschorge this period'
Out"fall Date 00530 �DQ,400 00 6 ', �,; ,
Nom Sample Collected, Total Sus�de pH, R rkg000lar Oil and Grease/TPHEPA N�eJw,Motor Oil Usage,
m_o/add/,yr Solids, 5tanda d units hod165GT�HEM), mg/L Annual �erage gal/mo
1Be chmark 0%Wj,F �M. ! 0 orz1U0 ee permit' Within 6 0�'= 9 0 ��1�5 ,
�� O 1Y ►i Lq LS ka t:;Ytp
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month ✓ yes _no
(if yes, report your analytical results in the table immediately below)
PartB Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
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 October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS
Date (first event sampled)
Total Event Precipitation (inches) Itz"
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 11 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 ANYONE OUTFALL7 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, includina all "No Dischorae" reports, within 30 days of receipt of the lab results for at end of monitorina 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
(Date)
Additional copies of this form may be downloaded at http //porta( ncdenr orR/web/wq/ws/su/npdessw#tab-4
SWU-250 last revised October 25, 2012
Page 2 of 2