NCG180194_MONITORING INFO_20181203

STORMWATER DIVISION C
NCG PERMIT!
PERMIT NO.
DOC TYPE ❑ HISTORICAL FILE
0' MONITORING RE
DOC DATE i] c� 0 I � /)-
YYYYMMDD

STORM W ATER DISCHARG I OUTFALL (SDO)
MONITORING RI PORT
Certifiicate of Coverage No NCG 180194 SAA1 PLES COLLFCTED DURING CALFNDAR YEAR 2018
(This monitoring report shall be recen ed by the Dn ision no later than 30 days
from tho- date the facility recenes the sampling results from the laboratory }
FACILITY NAME KLAUSSNER FURNITURE INDUSTRIES fall__ COUNTY RANllOLPH
PERSON COLLECTING SAMPLE(S) SUSAN FEIR PHONE NO ( 3 } 625-6174
CERTIFIED LABORATORY(S) MFRITECH Lab # 165 DEC 0 3 2018
Lab # (SIGNATURE OF PERMITTEE OR DESIGNEE)
____C1_NTRAL FILES By this signature, I cE rtify that this report is accurate
DVJR SECTION complete to the best of mN knowledge
Part A Vehicle Mauzicnance Activity Monitoring Requirements (only if, on average, more than 55 gallon% per month of neNs motor oil is used)
i) n t fa I I
No
Date
Sample Collected,
mo/dd/yr
I
Total Rainfall,
inches
1
New Motor Oil Usage,
Annual average
gal/mo
00556
00530
00400
Oil and Crease,
mg/L
Non -polar O&G/TPH
(Method 1664 SGT-HEM),
if appl
Total Suspended Solids,
mg/L
pH,
Standard units
Benchmark
-
-
-
30
15
100
6 0— 9 0
KFI Al
10/1 1/2018
1 76
10
78
Note If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pi 1, you must implement Tier 1 or Tier 2 responses in the General Permit
Mail Original and one copy to
Division of Water Quality
Attic Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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)
I /_'p- / -.l_ L?
(Date)
Form SWU-254-062310
Page l of 1

Certificate of Coverage No NCG 180194,
S I ORM WA CER DISCHARGE OUTIF ALL (SDO)
MONITORING REPORT
SAMPLES COLLECI ED DURING CALENDAR YEAR 2018
( I his monitoring report shall be received by the Division no later than 30 days
REf oin the date the facility receives the sampling results from the laboratory
�° L_ t )
V l.` L )
FACILITY NAME, KLAUSSNER FURNI FURE INDUS I RIL S AUG
PERSON COLLECTING SAMPLE(S) SUSAN F! 1R
CER HFIED LABORATORY(S) MERITECH Lab # 165 C hi, i�,,L' F!I_Efi
Lab # OOJR 3 CTIONi
COUNTY RANDOLPH
PHONE NO ( 336 ) 625-6174
(SIGNA7 URE OF PERM IT I EE OR DESIGNEE)
fly this signature, I certify that this report is accurate
complete to the, best of my knowledge
Part A Vehicle Maintenance Activity Monitoring Requirements (only if, on average, more than 55 g illons per month of new motor oil is used)
Outfa-11-1
No
Date I
Sample Collected,
mo/dd/yr
Total Rainfall,
inches
I -
New Motor Oil Usage,
Annual average
al/mo
00556
00530
00400
Oil and Grease,
mg/L
Non -polar O&G/TPH
(Method 1664 SGT HEM),
if appi
Total Suspended Solids,
mg/L
pH,
Standard units
Benchmark
-
-
-
30
15
100
6 0 — 9 0
KFI # 1
5/30/201 H
022
< 5
62
Note, I1 you report a Sampled value, in exLLSS of the, benLhmark value or outside the benLhni irk r Inge, for pH you mule imple.muu Tier 1 or rie.r 2 rLSponSeS in the Gtntral Pc rime
Mail Original and one copy to
Divtuon of W Iles Quality
Attn Central firllS
1617 Mail Strvi(,e, Ci nti t
Raleigh Norih Carolina 27699-1617
"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, aecuratc., and complete
1 am aware that there are significant penalties for submitting false information, including the, possibility of fines and imprisonment for knowing violations "
(Signature of Pernuttee)
7-/ ,?- l�
(Date)
form S W U-254-062110
Page 1 of 1

i
M STA� 4
RECEIVE P
��.. NOV 27 _fa
CEN Stormwater Discharge Outfall (SDO) DwR`� CTI10N
Qualitative Monitoring Report
Permit No N/C/ G / II $ I 0 / 0 / 0 / 0/ or Certificate of Coverage No N/CIG/ I / 8/ 0 / I / 9 / 4 1
Facility Name KLAUSSNER FURNITURE INDUSTRIES
County RANDOLPH Phone No 336-299-7211
Inspector SUSAN FEIR
Date of Inspection iD /1 3 % r 7
Time of Inspection .? Pm
Total Event Precipitation (inches) U OS
Was this a Representative Storm Event`i (See information below) 0 Yes ❑ No
Please check your permit to verify if Qualitative Monitoring must be performed during a representative
storm event (requirements vary)
A "Representative Storm Event" is a storm event that measures greater than 0 1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0 1 inches has
i
occurred A single storm event may contain up to 10 consecutive hours of no precipitation
By this signature, I certify that this report is accurate and complete to the best of my knowledge
(Signature of Permittee or Designee)
I Outfall Description
OutfalI No KFI #I Structure (pipe, ditch, etc ) DITCH
Receiving Stream UNNAMED TRIBUTARY TO CEDAR FORK CREEK, CAPE FEAR RIVER BASIN
Describe the industrial activities that occur within the outfall drainage area
FURNITURE MANUFACTURING
2 Color Describe the color of the discharge using basic colors (red, brown, blue, etc ) and tint
(light, medium, dark) as descriptors C )e<.-
3 Odor Describe any distinct odors that the discharge may have (i e , smells strongly of oil, weak
chlorine odor, etc ) t)0PA e-
Page I of 2
SWU 242 112608

a
4 Clarity Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy
2 3 4 5
5 Floating Solids Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids
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 is extremely muddy
2 3 4 5
7 Is there any foam in the stormwater discharge? Yes No
8 Is there an oil sheen in the stormwater discharge? Yes CNo
9 Is there evidence of erosion or deposition at the outfal19 Yes No
10 Other Obvious Indicators of Stormwater Pollution
List and describe 6 vn e-
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
SWU 242 112608

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Certificate of Coverage No NCG 180194 SAMPLES COLLECTED DURING CALENDAR YEAR 2017
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory)
FACILITY NAMIJ KLAUSSNER FURNITURE INDUSTRIES COUNTY RANDOI.PH
PERSON COLLECTINGSAMPLE(S) SUSAN FEIR PHONE NO ( 336 ) 625 6174
CERTIFIED LABORATORY(S) MERITECH Lab # 165
Lab # (SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge
Part A Vehicle Maintenance Activity Monitoring Requirements (only if, on average, more than 55 gallons per month of new motor oil is used)
V� t
Outfall
No
Date
Sample Collected,
mo/dd/yr
1
Total Rainfall,
inches
1
New Motor Oil Usage,
Annual average
aUmo
00556
00530
00400
Oil and Grease,
mg/L
Non -polar O&G/TPH
(Method 1664 SGT-HEM),
if appi
Total Suspended Solids,
mg/L
pH,
Standard units
Benchmark
-
-
-
30
15
100
b 0 — 9 0
K FI # 1
10/ 13/2017
005
< 5
72
Note If you report a samPIed value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier 2 n,spomes in the General Permit
Mail Original and one copy to
Division of Water Quality
Attn Central Files
1617 Mail Service Censer
Raleigh, North Carolina 27699-1617
"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 "
l/-/S---
(Date)
Form SWU-254 062310
Page 1 of I

-4
Certificate of Coverage No NCG 180194
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING RFPORT
SAMPLFS COLLFCTED DURING CALF NDAR YFAR 2017
(This monitoring report shall be i eceived by the Division no later than 30 days
from the date the facility receis es the sampling results from the laboratory )
FACILITY NAME KLAUSSNER FURNITURE INDUSTRIES RECEIVED
PERSON COLLECTINGSAMPLE(S) SUSANFFIR �J
CERTIFIED LABORATORY(S) MERITECH Lab# 165 JUL 28 au
Lab #
CENTRAL FILES
DWR SECTION
COUNTY RANDOLEIJ
PHONF NO ( 336 ) 625-6174
(SIGNATURE OF PERM ITTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of my knowledge
Part A Vehicle Mamftnance Activity Monitoring Rt quirements (only if, on average, more than 55 gallons per month of new motor oil is used)
Outfall
No
Date
Sample Collected,
moldd/yr
1
Total Rainfall,
inches
1
New Motor Oil Usage,
Annual average
al/mo
00556
00530
00400
Oil and Crease,
mg/L
Non -polar O&G/TPH
(Method 1664 SGT-H F'M),
if appl
Total Suspended Solids,
mg/L
pH,
Standard units
Benchmark
-
-
-
30
15
100
6 0 — 9 0
KF I# I
6/ 16/2017
057
< 5
69
Note If you report a sampled value in excess of the bent hinark value., or outside the benchmark range for pH, you must implement Tit,i I of Tier 2 tesponSLS in the General Permit
Mail Original and one copN to
Division of Water Quality
Attn Central files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or superN ision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted Based on mN mquiry 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 "
L
(Signature of Perimttee)
(Date)
Form SWU-254-062310
Page I of I

Sl ORM WATER DISCHARC F OUI FALL (SDO)
MONITORING RI+PORT
certificate of Coverage No NCG l80194
FACILITY NAMI KLAUSSNER FURNITURE INDUSTRIFS
PF RSON COLLECTING SAMPLES) SUSAN FFIR
CERTIFIFD LABORA rORY(S) MERITECH Lab # 165
Lab #
SAMPLES COLLECTFD DURING CALFNDAR YEAR 2017
(This monitor ing report shall be received by the. Division no later than 30 days
from the date the facility receives the sampling results from the laboratory )
COUNTY RANJ)OLPH
PHONE NO (_336 }_625-6174
(SIGNATURL OF PERM ITTEE OR DFSIGNFF)
By this signature, I certify that this report is accurate
complete to the best of my knowledge
Part A Vehicle Maintenance Aetrvity Monitoring Requirements (only if, on average, more than 55 gallons per month of new motor oil is used)
Outfall
No
Date
Sample Collected,
mo/dd/yr
1
Total Rainfall,
inches
1
New Motor Oil Usage,
Annual average
al/mo
00556
00530
00400
Oil and Grease,
mg/L
Non -polar O&G/TPH
(Method 1664 SGT-11F M),
if a ]
I otal Suspended Solids,
mg/L
pH,
Standard units
Benchmark
-
-
-
30
15
100
6 0 — 9 0
KFI It 1
6/16/2017
057
< 5
69
Notc. If you report a sampled value in excess of the benchmark value, or outside the benchmark range for p11, you must iniplement Tier I or I ier 2 responses in the Gencral Pci nut
Mail Original and one copy to
Division of Water Quality
Attn Central I Eles
1617 Mail Service C(aitet
Raleigh, North Carolina 27699 1617
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a %ystem 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 pLiialties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
4-0-- L ')
ture of Permittee)
(Date)
Form SWU-254 062310
Page 1 of 1

North Carolina Division of Energy, Mineral, and Land Resources
SEMI-ANNUAL STORMWATER OUTFALL DISCHARGE MONITORING REPORT (DMR)
Vehicle Maintenance Activities Only
Date submitted J Z— z- 9 - r
CERTIFICATE OF COVERAGE NO NCGL _�' 01
RECEIVE�MPLECOLLECTION YEAR 20L �2
FACILITY NAME kLA JSSN E i2 Fuj2N iTg 2E aNpoS i Q1 ES JAN 18 l G' I
COUNTY OL
PERSON COLLECTING SAMPLES A N FE r
LABORATORY M E—Q TEC i-+ Lab Cert # 14,
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE -�
C)WR SECT EON
Vehicle Maintenance Activity (VMA) Stormwater Monitoring Results Only for facilities using an average of > 55 gal of new motor oil per month
Total event rainfall 2 IIr or 0 No discharge this perrad2
&Outfall No 11
&
y
i rya3
�', Sam le'', ri
� p p w
Collected;
Qt >
Ernm/dd/yr,r��(ifapplicablej,r
�u, j otal sus ended: `;
d T� , p �
i z N.xy t �..
a Solids (Tssj, mg/L�
Non-polar,0&Gi�'PH, mgJL
- + x
'��{Method 16G4TSGT-l1EM) ,
4`
,oil'and Grease m L''
8/
e u - 'ik a a � ' eL i Y
(if applh6bte)1 ii{if
l u $k
�F
f1f>
��l H standard "units ° `.
� p%"L : � �
€w 4 :. „a =ra qn+.n
apphcable)� ey{�
fp
E L �1
,lt" E �4.,d+�`ON
f eiiv Motor Oil Usa eR m
N � g .,p�,
t're� L'^
l 'Annual average gal/ma rh
s yMl
ana,h�
yy Pip
Benchmark;"=G,
P
b�s,iW7 or 50sx
°' iSfflj: r
Mr30r7r�
p
,.'Within b`0t 5a�Fz
1
a: zg Zor6
r
7-7
The total precipitation must be recorded using data from an on -site rain gauge
2 For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
3See General Permit text that identifies the especially sensitive receiving water classifications where the more protective TSS benchmark applies
Note Results must be reported in numerical format For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or any other similar non -
numerical format When results are below the applicable limits, they must be reported in the format, "<XX me/L", where XX is the numerical value of the
laboratory's detection limit, reporting limit, etc in mg/L
Note if you report a sample value in excess of the benchmark, you must implement Tier I, Tier 2, or Tier 3 responses
FOR MONITORING RESULTS
* A single benchmark exceedance triggers TIER 1 REQUIREMENTS See permit PART 11 SECTION B or C
• Two exceedances in a row for the same parameter at the same outfall trigger TIER 2 REQUIREMENTS
• TIER 3 Has your facility had four or more benchmark exceedances for the same parameter at anyone outfall?
IF YES Have you contacted the DEMLR Regional Office?
REGIONAL OFFICE CONTACT NAME
SWU-254'Vehicle Maintenance Activities DMR
See General Permit team
YES ❑ NO
YES ❑ NO
Last Revised August 11 2014
Page I of 2

Marl 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 Penrod in the case of "No Discharge" reports) to
Division of Water Resources
Attn DWR Central Files
1617 Mail Service Center
Raleigh, NC 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)
Ia-I-)Ir--l6
(Date)
Additional copies of this form may be downloaded at http j1portal ncdenr orgZweb/Ir/npdes-stormwater
SWU-254 Vehicle Maintenance Activities DMR Last Revised August 11 2014
f 1K Page 2 of 2

s
STORMWATER DISCHARGE OUTFALL (SDO)
W-10MITUREN REPORT
Permit Number NCS or
Certificate of Coverage Number NCG (c9 _
FACILITY NAMEA62F&tCAd1�C-----
PERSON COLLECTING SANIPLE(S)
CERTIFIED LABORATORY(S) Lab #_
Lab #
Part A Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR
(This monitoring report shall be received by the Division no later than 30 da)s from
the date the facility receives the sampling results from the laboratory )
COUNTS'
PHONE NO (�
(SIGNATURE OF PERMTTTEE OR DESIGNEE)
By this signature, I certify that this report Is accurate
complete to the best of my knowledge.
t}Da
1
te
ample
Collected
r r r
1
1 1 1
1
■
t
1
/ V"
1 ■
1tal Lead
1 1 /
Does thi, facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? — yes —no
(if yes, complete Part B)
Part B Vehicle Maintenance Activity Monitoring Requirements
Outfall
No
Date
Sample
Collected
50050
00556
00530 00400
Total Flow
(if applicable)
Total Rhinfall
Oil & Grease
Total pH
Suspended
Solids
New Motor Oil
U' sage
mo/dd/vr
IMG
inches
m
m Units
2 illmo
Form SWU-2,4` 112608
P 1 of 2

STORM EVENT CHARACTERISTICS Mail Original and one copy to
svision o Water u ity
Date�� l Files
Total Event Precipitation (inches) ?�� 1 Attu n Mad Service CentraFiles Center
Event Duration (hours) - 12_— (only if applicable — see permit) Raleigh, North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches)
Event Duration (hours) (only if applicable --see permit )
"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 th it qualified personnel properly gather and evaluate the information subntted Based on my inquiry of the pLrson
or persons who manage the system, or those persons directh responsible for gathering the informanon, the information submitted is, to the best
of my knowledge and belief, true, accurate, and complete I am aware that there are significant penalises for subiiuttmg false information,
including the possibility of fines and imprisonment for knoning violations "
312.a r
(Sign tore o ermittee) (Date)
Form SWU-246-1 12608
Pa of

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORLNG REPORT
Permit Number NCS or
Certificate of Coverage Number NCG__ _1770 i -
FACILITY NAME. ------__--
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR
(This mordtoruig report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory
COUNTY Stanw RtctiVEQ
PHONE NO (_) - N-C @ 6 Z016
(SIGNATURE OF PERNiI ITEE OR DESIG„1,)-RAL FILES
By this signature, I certify that this report is gaPAMBECTI ON
complete to the best of my knowledge.
O
_62te
SampleNo
Collected
• p•
.
r
Does thi+ facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month) —yes _no
(if yes, complete Part B)
Part B Vehicle Maintenance Activity Monitoring Requirements
Outfail
No
Date
Sample
Collected
SK5-0
00556
00530
00400
Total Plow
(if applicable)
Total Rinnfall
Oil & Grease
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/ r
MG
I inches
I rujo
m
Units
gailmo
Form SWU-2,4' 112608
�,_ loft

STORM EVENT ClIkRACTERISTICS
Date 17Z-i- 1(a
Total Event Precipitation (mches) I Z s
Event Duration (hours) t 7 - (onl) if applicable -- see permit }
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches)
Event Duration (hours) (only if applicable -see permit)
Mail Original and one copy to
Divtsion of Water Quality
Attn Central Files
1617 Mad Service Center
Raleigh Korth Carolina 27699-1617
"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 subnntted Based on m) inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the inforinainon, the information subnutted is, to the best
of my knowledge and belief, true, accurate, and complete I am aware that there are significant penalties for subnutting false information,_ _
including the posstbdity_of fines and imprisonment for knoning violations "
I2-I-ZOU0
(Signature of Permittee) (Date)
Form SWU-246-112608
Pa of 2

North Carolina Division of Energy, Mineral, and Land Resources
SEMI-ANNUAL STORMWATER OUTFALL DISCHARGE MONITORING REPORT DMR
Vehicle Maintenance Activities Only
Date submitted _TjL-Y , 261, ,
S
CERTIFICATE OF COVERAGE NO NCG�� I �` _ lf� SAMPLE COLLECTION YEAR .26)(6
FACILITY NAME KLAu_-�SAj P 9 Fu12 /u
COUNTY RA,�OaLp:-'14 LU16
PERSON COLLECTING SAMPLES _ Su�S/} rC �� PLEASE REMEMBER TO SIGN ON THE REVERSE 4
LABORATORY J"isjZ►Tt_L0 Lab Cert # lti� C�i�tTFcaL FILES
DWR SLG�ION
Vehicle Maintenance Activity (VMA) Stormwater Monitoring Results Only for facilities using an average of > 55 gal of new motor oil per month
Total event rainfall' a 3y or ❑ No discharge this period'
Outfall No
Sample
Collected,
mm/dd/yr
Total Suspended
Solids (TSS), mg/L
Non -polar O&G/TPH, mg/L
(Method 1664 SGT-HEM)
(if applicable)
Oil and Grease, mg/L
(if applicable)
pH, Standard units
(if applicable)
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
100 or 50
1s
30
Within 6 0 — 9 0
-
wort
1 The total precipitation must be recorded using data from an on site rain gauge 111111:1111101OD
Z For sampling periods with no discharge at Iny outfalls You must still submit this discharge monitoring report with a checkmark here
3See General Permit text that identifies the especially sensitive receiving water classifications where the more protective TSS benchmark applies
Note Results must be reported in numerical format For example, do not report Below Detection Limit, 8DL, <PQL, Non -detect, ND,, any other similar non -
numerical format When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the nu�nerr al value of the
laboratory's detection limit, reporting limit, etc in mg/L 0
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 MONITORING RESULTS
• A single benchmark exceedance triggers TIER 1 REQUIREMENTS See permit PART 11 SECTION B or C
• Two exceedances in a row for the same parameter at the same outfall trigger TIER 2 REQUIREMENTS
• TIER 3 Has your facility had four or more benchmark exceedances for the same parameter at any one outfall? YES ❑ NO ❑
IF YES Have you contacted the DEMLR Regional Office? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
SWU-254 VLIIICle Maintenance Activities DMR Last Rci ised August 11 2014
Page 1 of 2

Marl an original and one copy of this DMR1_ 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 Resources
Attn DWR Central Files
1617 Mail Service Center
Raleigh, NC 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)
(Date)
Additional copies of this form may be downloaded at http //portal ncdenr org/web/Ir/npdes stormwater
SWU-254 Vehicle Maintenance Activities DMR Last Rcvtscd August 11 2014
Page 2 of 2

North Carolina Division of Energy, Mineral, and Land Resources
SEMI-ANNUAL STORMWATER OUTFALL DISCHARGE MONITORING REPORT DMR
Vehicle Maintenance Activities Only
Date submitted I?C C 6 NL7r)Z 20/S
CERTIFICATE OF COVERAGE NO NCG / L 0I % `�
FACILITY NAME kiALi5i IVCR Full/v ,Tu2L
COUNTY AA*V4Do L pH
PERSON COLLECTING SAMPLES - USAAf rC-,,q
LABORATORY , Fc Lab Cert #i 16 -1—
SAMPLE COLLECTION YEAR 2G�S
RECEIVED
FEB 0 g 2016 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES
Vehicle Maintenance Activity (VMA) Stormwater Monitoring Results Only for fa+v+lit+es using�an average of > 55 gal of new motor oil per month
Total event rainfall' 4 / or ❑ No discharge this period
Outfall No
Sample
Collected,
mm/dd/yr
Total Suspended
Solids (TSS), mg/L
Non -polar O&G/TPH, mg/L
(Method 1664 SGT-HEM)
(if applicable)
oil and Grease, mg/L
(if applicable)
pH, Standard units
(if applicable)
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
100 or 50
1s
30
Within 6 0 — 9 0
-
Gi
17 2 61 S`
' The total precipitation must be recorded using data from an on -site rain gauge
Z For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
aSee General Permit text that identifies the especially sensitive receiving water classifications where the more protective TSS benchmark applies
Note Results must be reported in numerical format For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or any other similar non
numerical format When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the
laboratory's detection limit, reporting limit, etc in mg/L
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 MONITORING RESULTS
• A single benchmark exceedance triggers TIER 1 REQUIREMENTS See permit PART II SECTION B or C
• Two exceedances in a row for the same parameter at the same outfall trigger TIER 2 REQUIREMENTS
• TIER 3 Has your facility had four or more benchmark exceedances for the same parameter at any one outfall? YES ❑ NO ❑
IF YES Have you contacted the DEMLR Regional Office? YES [:]NOD
REGIONAL OFFICE CONTACT NAME
SWU-254 Vehicle Maintenance Activities DMR Last Revir Ld Aui:ml 11 2014
Pa4'c, 1 of 2

Marl 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 Resources
Attn DWR Central Files
1617 Mail Service Center
Raleigh, NC 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 Rermittee) (Date)
Additional copies of this form may be downloaded at http //portal ncdenr org/web/Ir/npdes-stormwater
SWU-254 Veluc,lC Mdin(c,naiiLL ALtivini s DMR Last Rc,vrsed August / / 2014
Page. 2 of 2

North Carolina Division of Energy, Mineral, and Land Resources
SEMI-ANNUAL STORMWATER OUTFALL DISCHARGE MONITORING REPORT (DMR)
Vehicle Maintenance Activities Only
�� �I V LJ
AUG 10 m5
Date submitted _TU Y 261 S CENTRAL FILES
DWR SECTION
CERTIFICATE OF COVERAGE NO NCG 1U I �� _ SAMPLE COLLECTION YEAR 2�I
FACILITY NAME A,,TJR
COUNTY RANDo )4
PERSON COLLECTING SAMPLES _ �LiljA^I FP-o)Z PLEASE REMEMBER TO SIGN ON THE REVERSE 3
LABORATORY Mef2 i izC t4 Lab Cert # / ioS
Vehicle Maintenance Activity (VMA) Stormwater Monitoring Results Only for facilities using an average of > 55 gal of new motor oil per month
, Total event roinfall' j % or ❑ No discharge this period
Outfall No
Sample
Collected,
mm/dd/yr
Total Suspended
Solids (TSS), mg/L
Non -polar O&G/TPH, mg/L
(Method 1664 SGT-HEM)
(if applicable)
Oil and Grease, mg/L
(if applicable)
pH, Standard units
(if applicable)
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
100 or 50
15
30
Within 6 0 - 9 0
-
F� # I
u-C 1 2cii"
S .If
777
1 The total precipitation must be recorded using data from an an -site rain gauge
2 For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
3See General Permit text that identifies the especially sensitive receiving water classifications where the more protective TSS benchmark applies
Note Results must be reported in numerical format For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or any other similar non -
numerical format When results are below the applicable limits, they must be reported in the format, "<XX mg/L" where XX is the numerical value of the
laboratory's detection limit, reporting limit, etc in ing/L
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 MONITORING RESULTS
• A single benchmark exceedance triggers TIER 1 REQUIREMENTS See permit PART II SECTION B or C
• Two exceedances in a row for the same parameter at the same outfall trigger TIER 2 REQUIREMENTS
• TIER 3 Has your facility had four or more benchmark exceedances for the same parameter at any one outfall7 YES ❑ NO[?"
IF YES Have you contacted the DEMLR Regional Office? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
7--
r
SWU-254 Vehicle Maintenance Activities DMR Lasi Rcmtd 4uguil 11 2014
Page I of 2

Mail an orrainot and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results f or at end of
monitoring period to the case of "No Discharge" reports) to T
Division of Water Resources
Attn DWR Central Files
1617 Mail Service Center
Raleigh, NC 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, a.curate, and complete I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations " 1"0
(Signature of Permittee)
7-1'7-�
(Date)
Additional copies of this form may be downloaded at http //portal ncdenr org/web/lr/nodes„stormwater
SWU-254 Vehicle Maintenanc,c. Activities DMR Lai! Rcvisc.d August 11 2014
Page 2 of 2