NCG080387_COMPLETE FILE - HISTORICAL_20161216

STORMWATER DIVISION CODING SHEET
RESCISSIONS .
PERMIT NO.
DOC TYPE
❑COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
❑ 301
YYYYMMDD

(? Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000 1(0
Date submitted t)cc.. M. 10vo �n
CERTIFICATE OF COVERAGE NO. NCG08 0 0 O 0 I AMPLE COLLECTION YEAR
FACILITY NAME — I hliL aet+It �nSlorbq0V SAMPLE PERIOD ❑ Jan -June July -Dec
COUNTY < ,,,, t�~�r �7 or ❑ Monthly`_ _ _ (month)
PERSON COLLECTING SAMPLES ��y ,,- aj:) � DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY F r�Lv L bCert.tl RECEIVED ❑Zero -flaw ❑Water supply ❑SA
Comments on sum le coilectigqn or,-rnalys,
[]Other►h.r_���1��� ►� tA1o/ t o iv k6k-L DEC 16 '1016
I'I.EASL HCMF:MtiCR'rC1 SIGN ON I HI. itEVl:RSE �
N..�Stio.� CENTRAL FILES
Part A: Vehicle Maintenance Areas Monitonng Requirements DWR SECTION ❑ No discharge this period r
�Outfali
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
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
hill Iiris facility pet form VChICIc td1ai111+7n:ince Activities using more than SS gallons of new motor oil per month? — yes /nn
(if ytts, report your analytical result; in the table immediately below)
Part 0: Oil/water Separators and Secondary Containment Areas at Petroleum Sulk Stations and Terminals
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/L
pH,
Standard units
Permit Limit
15
50 or 100 see permit
6.0 — 9.0
For sampling per iod,i with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWE :•'jrl la>[ reviwd Qcloher 25.20I'
Pagc 1 01

t
STORM EVENT CHARACTERISTICS:
Date tt'l'1$0 (first event sampled) 0
Total Event Precipitation (inches):
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 0 MONITORING_RESUIT5:
• A BENCHMARK EXCCEDANCE TRIGGERS TIER 1 REQUIREMENTS, SEE PERMIT PART It SECTION 0.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO t:J
REGIONAL OFFICE CONTACT NAME:
Mail an aricfinaf and one copy of this DMR, includin�Tl"o plsi:horaereports. within 30 days of receipt of the !ab results for at end of monitoring period in
the case of "No Oischarae" reports) to:
Division of Water Ouality
Attn: UWO Ceotr'aI Files
1617 Mail 5civice Center
Raleigh, North Carolina 27699-1617
YOU must SIGN rill CERTIFICATION FOR ANY INI ORMATI N REPORTED;
"I Certify, under penahy 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 property 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 %il penalties for sulrnitting false information, including the possibility of fines and imprisonment for knowing violations."
�altyl��
(Signature of Permittee) �Datej
Additional copies of this form may be downloaded at: htt r fpnrtal.rlcdenr.orp/web/wq/wslsu�pdLsswgtab•4
ti11'l l-�iI? last revised October 25. 2012
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