NCG080109_MONITORING INFO_20190203

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v
DOC TYPE
❑-/ HISTORICAL FILE
L� MONITORING REPORTS
DUC DATE
0
YYYYMMDD

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted l i Z 12�0 Z C)
CERTIFICATE OF COVERAGE NO. NCGO$c) 1 D SAMPLE COLLECTION YEAR �LLZ�;
SAMPLE PERIOD Q Jan -June ❑ July -Dec
FACILITY NAME Ci�Ar_�;D I�4^7h,,--i�iy:h+:l� T��:�t�i�fT�
COUNTY-
PERSONML+�L�N ruV� Cr'c. or.:.❑ Monthly' - (month)
COLLECTING SAMPLES ,,DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY'SrenC-� �uvi�uv;M�,�,t LabCert. L 3��S ��` 1 VV ❑Zero -flow [:]waterSupply [:]SA ...
Comments ©Other G k,,,, C on sample collection or analysis: �pj� —
Part A: Vehicle Maintenance Areas Monitoring Requirements`
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
El No discharge this period'
OutfaA
No.
Date
Sample Collected,
mo/_tltl/,y_r
Q0530
d04 _q
'� 005. _
`Total Suspended
i 'Solids, mg/L
pH,
Standardunits
Non -Polar Oil a Gr'e/TPH EPA
Method 16fi4 (SGT HEM), mg/L
-
New Mot ro Oil
Annual average
Usage,
gal/�mo
Bencd a�k501orr�"�"100se
permits
W_ iih+n 6.09'�0
15N
-
0 �-1
2
b•
N ,
'C:
. O t; , ;•+ ..
. .
Did'this facility perform VehicleMaintenance Activities using more than 55 gallons of new motor oil per month? yes _no
(if yes, repodyour analytical resulis in the table lmrinediately below)=
Part B: Oil/water Separators and �Secondary•Contain ment Areas at,Petroleum Bulk'Statibns and Terminals
Outf II
No.
.Date
Maple Collected,
no/,dd%y'r
y0056
'Non-Polar'�Oil
00530
00400
pH,
fff�tanctard units_
and Grease%TPH EPA Method
ifi64 {SGT HEMj, mg/L
Totai Susp'ed d Solids, +
mg/,L
Pe_rmit,limit
1S
59or 10(Xsee permit
G.0-9.0
+ For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SVIrU-250 _ last revised O �r 25• 2012
-page 1 of?

STORM EVENT CHARACTERISTICS:
Date.-11-)(10 (first event sampled)
Total Event Precipitation (inches): -L
-Date (list -each additional event -sampled this reporting period; and rainfall -amount) -
3
Total Event Precipitation (inches):
Note: If you report a`sample'`volue in excess of the benchmark; you.'must implement Tier 1, Tier 1, or Tier 3'responses. See Genera! Perrrrit text:
FOR PART:AAND PART B MONITORING RESULTS: ;; _, t ?,+; �•• . ; :r,:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2:EkEEDANCES41N°A ROW FOR'THE SAME PARAMETER AT -THE SAME OUTFALC"TRIGGER•TIER 2-REQUIREMENTS. SEE PERMIT PART II'SECTION 3.
• 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 REGibNAi. 601CO ' YES ❑ NO ❑ '
REGIONAL OFFICE'CONTACT NAME:
i
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results r'or at end of monitoring period in
the caste "'No Discharge" reports 6to:
Division of Water Quality
Attn: DWQ Central Files $ _-
1617 Mail'Service Center-
Raleigh .North Carolina. 27699;1617 , • _
�.�-��� L:
YOU MUST SIGN -THIS CERTIFICATION FOR ANY INFORM-ATION REPORTED: _.' i-::
"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 1.the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for`gathe'ring thJ.e'information,'the information submitted is, to the best of my knowledge and belief, true, accurate, and cotmplete.- 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/wq/ws/su/npdessw#tab-4.,.
-- ;
SWU-250 last revised October 25, 2012
Pace? oft