NCG160200_MONITORING INFO_20181211

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
------------------
DOC TYPE
❑ HISTORICAL FILE
4 MONITORING REPORTS
DOC DATE
❑ Ap J Ia
YYYYM M D D

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General perrrot No. NCG160000 -Asphalt
Date submitted /8
CERTIFICATE OF COVERAGE NO NCG160a O O
FACILITY NAME fi2t UjeST t--) N usE
COUNTY Mcr+✓ vs-4uR�,
PERSON COLLECSTVIN,G SAMPLES uAK95 Fk, W,
LABORATORY rKLSM Lab Cert. if Dn�
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR (" Ys l
SAMPLE PERIOD Jan -Jun July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
Other CLASS Ct
PLEASE REMEMBER TO SIGN ON THE REVERSE -30
outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
Benchmarks =__>
-
-
100 mg/L or 50 mg/0
-L-
No discharge this period?'
RECE'vF-1)- --- -
DEC 11 ZMW
CENTi�L FILES
pWR SEC?IO^J
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
' 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.
" See General Permit text, Table 3, 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, "<XX mR/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019 Page 1 last revised 9/17/2014
f
Page 1 of 2

®)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > SS gal of new oil per month.
n No discharge this period?'
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
-
-
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
N/A
A!o VE-14i eL4-i,-
MA(ti r 6/,jC<t
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 SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL?
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME: NIA
YES ❑ NOX
Mail an original and one copy of this OMR 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, 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
11
(DAlel
Permit Date: 1011/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Pi?rmj*t No. NCG160000 - Asphalt
Date submitted �('Ij/ / g
CERTIFICATE OF COVERAGE No... NCCG_160 P- 0 _0
FACILITY NAME IkA 7X a{kO
COUNTYI �+
PERSON COLLECTING SAMPLES
LABORATORY iReK% Lab Cert. q Zia
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR C010 /6
SAMPLE PERIOD ❑ Jan -June N July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
]Zero-flo�wt� Water Supply ❑SA
Other (24 C_
PLEASE REMEMBER TO SIGN ON THE REVERSE i
No discharge this period?'
Outfall No.
Date Sample
Collected Iamount,
(mo/dd/yr)
24-hour rainfall
Inches;
Total Suspended Solids
Benchmarks
100 mg/L or 50 mg/L
D ZAW
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
' For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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.
" See General Permit text, Table 3, 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. "<XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n �, a:- �_ - _ �,� NA
Outfall No
Date sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total suspended Solids
Benchmarks �>
_
-
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Par
No VLXHICLA67
mp ,x"M% <
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 SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES [-I NO
REGIONAL OFFICE CONTACT NAME: X/^
Mail an original and one may 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 Resources
Attn: DWR 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2

CERTIFICATE OF COVERAGE NO. NCG16
FACILITY NAME �"41'..E LJrSl7>`l'ai-ixKt:
COUNTY McCl�1r� /�t1xa
PERSON COLLECTING SAMPLES
LABORATORY iPRlSrti Lab Cert. N
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted 7 /G /G Y
SAMPLE COLLECTION YEAR 'IN S 1 l f �1 Of,
SAMPLE PERIOD Jan -June ❑ July -Dec
or U Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply []SA
1�Rbther C
R1
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Total Suspended Solids
Benchmarks =__>
_
-
100 mg/ L or 50 mg/L
1. L
qm L
rrow
No discharge, this'period?z
DECEIVED
JUL 13 2018
CENTRAL FILES
DWR SECTION
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance 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.
" See General Permit text, Table 3, 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, "<XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 1 of 2

J Part BVehicle Maintenance Area Monitoring Results: only for facilities raging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
r
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
-
-
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
Note: If you report o 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 SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL?
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
YES ❑ NO
•
Mail on 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 Resources
Attn: DWR 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."
r 7 /6
(Signature of Permittee) (Date)
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

t/15120ia
orth Carolina DEMLR General
Date submitted
CERTIFICATE OF COVERAGE NO.
FACILITY NAME `�✓ i Ih JSt
COUNTY
PERSON COL L TINGSAMPLES�r'.L(�l�iG�li
LABORATORY--t%L3___�.,Lab Cert. If
Comments on sample collection or analysis:
Part A: Stormwdter Benchmarks and Monitoring Results
to�h NCG166000-Asphalt
/ YS
SAMPLE COLLECTION YEAR I_! 1 q I
SAMPLE PERIOD []Jan -June July -Dec
orMonthly' (month)
DISCHARGING TO CLASS QORW []HOW (rout [:]PNA
Qtero-flow Owater Supply [35A
Other CL^RSS
PLEASE REMEIvISFIt TO SIGN ON THE REVERSE -)
Outfall No.
Date sample
Collected'
(mo/dd/yr) ,.
24-hour rainfall
amount,
Inches'
Total Suspended Solids
8enchmarks�==>
-
-
100 mY/ta
i
)a 21 O
v
l iv /Z
ar .Jt:
v
----------------
No discharge this period?'
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'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.
See General Permit text, Table 3, 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, "cXX mg/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in nig/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier2, or Tier 3 responses. See General Permit text.
Permit Date: 10/1/2014-9/31/2019
SW U-252, last revised 9/17/2014
Page 1 of 2

1/15/2048
Part B: Vehicle Maintenance Area Monitoring Results: only forfbcilities averaging>55 gal of new oil par month. r
n No discharge this oeriod?
Outfall No.
Dale Sample
Collated'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G by EPA
1664 (SGT-REM)
ialal Suspended Solids
8cnchararks =__>
-
-
15 mg/l.
100 rrg/L or 50 mg/0
Footnotes from Part A also apply to this Part B
V67-ttGz-� _
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier2, or Tier 3 responses. See General Permit text.
FOR PART AAND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER I REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FORTHE SAME PARAMETER AT THE SAME OUTFALLTRIGGERTIER2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY 014E OUTFALL? YES ❑NO�
IFYES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES �r-J
NO
REGIONAL OFFICE CONTACT NAME: _________________________—______ NA
Division of WaterResources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699.1617
YOII 14041 SIGN 1111S CERTIFI D?TION FOR AN 1NFORMA.110F1 ICEPORTED:
"I certify, under penalty of law, that this document and all attachmentswere prepared under my direction or supervision in acordance with a 91stem designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or personswhomenage the system, or
those personsdirectly responsible forgathering the Information,the information submitted is, tothe-bestof my knowledge and belief,true, accurate, and complete. I
am aware that there are significant penaltle s for submitting false information, including the possibility of fines and impriiDnment for knowing violatlo ns."
(Signature of
Permit Date: 10/ l,/2014-9/31/2019
SW U-252, last re vise d 9/17/2014
Page 2 of 2

1/15/201 S.
North Carolina DEMLR General
Date submitted —
CERTIFICATE OF COVERAGE NO. NCG16 L� �
FACILITY NAME
COUNTY_M,.'�Cn;--
PERSON COLLECTING SAMPLES _ �25 J-
LABORATORY��t L;? ___,Lab Cert. If
Comments on sample collection or analysis:
Part A: StormwaterBenchmarks and Monitoring Reiults.
-Asphalt
SAMPLE COLLECTION YEAR
SAMPLE PERIOD Jan -June July -Dec
orMonthly' Imonth)
DISCHARGING TO CLASS QORW QHQW Drout E]PNA
Zero -flow Elwater Supply DA
Other CCPr5e>
PLEASE REMi'MBER TO SIGN ON THE R.EPERSE -)
No discharge this period?'
outfall No.
Date Sample
collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
-
Total. Suspended Solids
8eochararkr.==i
-
-
100 me/Lor -
i
Nb YL�✓
' Monthly sampling (instead of semi' -annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
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.
See General Permit text, Table 3, 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, "<XX mg/L", where XX is the numerical value of the
detection linjit, reporting limit, quantitation limit, etc. in frig/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.
Permit Date: 10/1/2014-9/31/2019
SW U-252, last revised 9/17/2014
Page 1of2

1/151201B
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging>55 gal of new oil parr month. IL
Jo
n No,dischorge this period,?
Dutfall No.
Date Sample
Collected'
(mo/dd/yr)
24-h our rainfall
amount,
Inches'
Non -polar O&G by EPA
1664(SGT-HEM)
Total Suspended Solids
aenchmarkir
15 mg/L
'
'10o sig/L or 50 mg/L77,
Footnotes from Part A also apply to this Part B
V/ 71 G
/U,9�Nrrr�l,c�
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 re3ponses. See General Permit text.
FOR, PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER I REQUIREMENTS.
• 2EXCEEDANCES IN AROW FOR THE SAME PARAMETER AT THE SAME QUTFALL T RIGGERTIER2 REQUIREMENTS.
• TIER31 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOP THE SAM . E PARAMETER AT ANY 0 1 NEOUTFALL? YES ❑N016
IFYES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES DNO
REGIONAL OFFICE CONTACT NAME: _ NA
Division of Water Resources
Attn: DW R Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOII M UST SIC+N TIIIS CER141 CATIUt! FOR ANY I III 'O 1114A'I [ ON ICE PU CITE I I:
"I certify, under penalty of law, thatthis document and all attachments were prepared undermy direction or supervision in acordance with a systern designed to
assure that qualified personnel properly gather and evaluate the information subiitted. Based on my inquiry of the person or personswhananage the system, or
those personsdlrectly responsible forgatheringthe information,the information submitted is, tothe bestof my knowledge and belief,true, accurate, and complete. I
am aware that there are significant penalties for submitting false information, including the possibility of finesand imprisinment for knowing violations."
(Signature of
Permit Date: 10/1/2014-9/31/2019
© � Ia e)
(date)i� /
SWU-252, last revise d 9/17/2014
Page 2 of 2

I
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year �—
Revised 9/1 014
General Permit No. NCG160000
Certificate of Coverage No. NCG 16P®©®❑
This monitoring report summary is due to the DEMLR Regional Office no later than November 1 of
each year.
Facility Name:
County:
zi
Phone Number: �j Total no. of SDOs monitored
Part A. Outfall No. (use multiple sheets for multiple outfalls)
Is this outfall currently In Tier 2 (monitored monthly)?
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 DEMLR to reduce monitoring frequency ❑
Other _ ❑
Outfall �
Total Rainfall,
inches
00530
TSS, mglL
Benchmark
N/A
100
Date sample Collected,wl'it
�
umolifdlyr
— 4•
S !�
-
f3rM•_
�1
L
Yes ❑ No k
Yes ❑ Nox
DEC 2 8 2016
CENTRAL FILES
DWR SECTION
I'age 1 1

4\
Part B. On -Site Vehicle Maintenance Outfall No. t / f ID W.)k
Is this outfall currently in Tier 2 (monitored monthly)? I I�! Yes ❑ No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ 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 DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall
Total Rainfall,
inches
00530
00556
TSS, mglL
Non-polar Oil &
Grease, mglL
Benchmark
N/A
501100
15
Date Sample Collected,
It"..$G.,,�'yFip .�M.Q�gy
% 4
ytse.
w-:..
"
12

"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."
Mail Annual DMR Summary Reports to:
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
2090 US Highway 70
Swannanoa, NC 28778
[phone]
3800 Barrett Drive
Raleigh. NC 27609
[phone]
585 Waughtown Street
Winston-Salem. NC 27107
[phone]
225 Grecn Street
SN'stel Building Suite 714
Fayetteville. NC 28301-5043
[phone]
WASHINGT61N RE610NAL OFFICE
943 Washington Square Mall
\vashington, NC 27889
[phone]
400RESVILLE,REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville. NC 28115
[phone]
WILNIINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
\Vihnington. NC 28405-2845
(9 10) 796-72 15

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year o 1
Revised 9/17/2014
General Permit No. NCG160000
Certificate of Coverage No. NCG16R . c7 PD
This monitoring report summary is due to the DEMLR Regional Office no later than November 1 of
each year.
Facility Name:
County: MX
Phone Number:
Total no. of SDOs monitored
Part A. Outfall No. (use multiple sheets for multiple outfalls)
Is this outfall curren in Tier 2 (monitored monthly)?
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 DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall i '
Total Rainfall,
inches
00530
TSS, mglL
Benchmark
N/A
501100
Date Sample, Collected,
p
molddlyr
qs``i
M-
D
R L3
MIR
tvw
t
jc
Yes ❑ No
Yes ❑ No
Page I I

I
Part B. On -Site Vehicle Maintenance Outfall No. Y "" U& I
Is this outfall currently in Tier 2 (monitored monthly)?
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 DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall
Total Rainfall,
inches
00530
00556
TSS, mg
Non-polar Oil &
Grease, mg/L
Benchmark
N/A
501100
15
Date Sample Collected,
mo/dd/yr
�s
5nrSM."
._
Yes ❑ No ❑
Yes ❑ No ❑
12

" 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, of
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."
Signs
Date
Mail Annual DMR Summary Reports to:
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
ASHEViILLEREGIONAI,PFFICE
F.1IEITEVILLE.REGIONALOFFIC�.
2090 US Hiehway 70
i 225 Green Street
Swannanoa, NC 28778
Systel Building Suite 714
[phone]
Fayetteville. NC 2830 1 -5043
(9 10) 433-3300
-. _ ...._.,. .._ -.— _. O- ....
RALEIGHRECIONALFFICE
- .._. -
i WASIILNGTONREGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
Raleigh. NC 27609
Washington. NC 27889
[phone]
[phone]
yVINSTON-SALENI REGIONAL
OFFICE
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
blOORESVILLE.REGIONAL OFFICE
610 East Center Avenue/Suite 301
\Mooresville. NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmineton. NC 28405-2845
(910) 796-72 15
Page 13

~ Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General ermi q. NCG160000 - Asphalt
Date submitted
CERTIFICATE OF COVERAGE NO. NCG16_v Ci G
FACILITY NAME t�UZe W65 71\6111 USt
COUNTY M� L�Nl3UZ.G
PERSON COLLECTING SAMPLES Cw-1_04,nCF1tfTY'
LABORATORY W 1SAA Lab Cert. k 0__2
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
c
SAMPLE COLLECTION YEAR COI
SAMPLE PERIOD' EJ�Jan-June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
����FFnn QOther C SS C
'�` WEASE REMEMBER TO SIGN ON THE REVERSE -i
JUN 1 0 1016
CENTRpL FI
DWR �E] No disch cqe this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Total Suspended Solids
Benchmarks ==>
_
-
100 mg/L eammw
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance 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.
" See General Permit text, Table 3, 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, "<XX me/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date:10/1/2014-9/31/2019 - SWU-252, last revised 9/17/2014
Page 1 of 2

0
r

� Part El:
Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
NIANo discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
3
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/L
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 PART B MONITORING RESULTS:
A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑ iii��______
REGIONAL OFFICE CONTACT NAME: M/A
Mail an original and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results tor 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, 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 asystem 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.
am aware that there are significant pegpities for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2

• •) •>
Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Per it No. NCG160000 - Asphalt
Date submitted 1' � a '
CERTIFICATE OF COVERAGE NO. NCG16 C a C C
FACILITYNJ1_ME
COUNTY <21GL�>1Jr�Ut2C
PERSON COLLE IIIGSAMPLESf—A%V4QIC luld
LABORATORY PiQ! Vl Lab Cert. ft �C
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
SAMPLE PERIOD ❑ Jan -June tgJuly-Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow []WaterSupply ❑SA
�F*therC4.H55 C
PLEASE REMEMBER TO SIGN ON THE REVERSE ->
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
To spended Solids
Benchmarks =__>
-
-
100 m r 50 mg/L
N A
�s
o pow
No dischorgepow,
DEC 1 i Zwi
CENTRAL FILES
D1NR SECTION _
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
' 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.
° See General Permit text, Table 3, 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, "<XX mR/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation limit, etc. in mg/L.
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.
SWU-252, last revised 9/17/2014
Permit Date: 30/1/2014-9/31/2019 Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
N1A
No •}
N�
n No discharge this period?'
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
-
15 mg/L
100 mg/L or 50 mg/L
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 1, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETERATTHE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFACE? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR including all 'No Discharge" reports within 30 days of receipt of the lab results (or at end of monitoring period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
'^ lJ
(Date)
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General P rmi No. NCG160000 - Asphalt
Date submitted 9 /
CERTIFICATE OF COVERAGE NO. NCG16 0O a 00
FACILITY NAME r0t7ZeC CoiZp Y 1 tiXNi CLi
COUNTY MFC&LeNji�JZG
PERSON COLLECTING SAMPLES A. 011, Tl i
LABORATORY PZl SfV\ Lab Cert. If L7
Comments on sample collection or analysis
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR �S
SAMPLE PERIOD NJan-June ❑ July -Dec
or ❑ Monthly' (month)
R�9l6fa] CLASS ❑ORW ❑HQW ❑Trout ❑PNA
CVs.•s v ❑Zero -flow ❑Water Supply ❑SA
3UR j g 2015 XOther CLP66 C
CENTR&6 FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
R DWS
5j No discharge this period?z
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Total Suspended Solids
Benchmarks =__>
_
-
100 mg/ r 50 mg/L
JV A
S
o rL-Ocv
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
' 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.
"See General Permit text, Table 3, 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, "<XX mR/L", where XX is the numerical value of the
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

AM

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
i�/a
❑ No discharge this period?'
Outfall No.
Date Sample
r
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM(
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or 50 mg/0
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 AND PART B MONITORING RESULTS:
• A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results (or at end of monitoring period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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 forgathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report (DMR)
for North Carolina DEMLR General Permit No. NCG160000 - Asphalt
Date submitted
CERTIFICATE OF COVERAGE NO. NCG16 D 0 0
FACILITY NAME 1"-dZc!9er:7COh-P PIH�(LIL�
COUNTY MJ_LatC�+t ( -
PERSON COLLECTING SAMPLES A
LABORATORY Pal SM Lab Cert. # %
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR ';;ko "S
SAMPLE PERIOD DKJan-June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
Other Lam` C
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
YNo discharge this period?'
Outfall No.
- -- -
Date Sample
r
Collected
(mo/dd/yr)—
24-hour rainfall
amount,
—Inches --
Total Suspended Solids
--`- -
Benchmarks =__>
-
-
100 mg/ r 50 mg/L
eolgLl /
. s
s M/ L
IQ A
S
o r-ocv
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
`4The 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.
"See General Permit text, Table 3, 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, NO, or 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
detection limit, reporting limit, quantitation 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.
Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ===>
_
-
15 mg/L
100 mg/L or 50 mg/L
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 AAND PART B MONITORING RESULTS:
A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS.
�. 2-EXCEEDANCES.IN.A. ROW FOR .THESAME PARAMETERAT_THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES [:1NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? 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 of 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, North Carolina 27699-1617
.4
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 forgathering 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."
1� /S
(Da e)
Permit Date: 10/1/2014-9/31/2019
SWU-252, last revised 9/17/2014
Page 2 of 2