NCG080715_DMR_20210723

Semi-annuaa Storrmwaterr Disch r e ManitoHng Rgpora
for North Caroiina Division of Water Quahy General Permit No. N00080000
CERTIFICATE OF COVERAGE NO.
FACILITY NAME /t 2 fir
COUNTY A /G
PERSON COLLECTING SAP
LABORATORY ✓/ Oq w.
Comments on sample colk
"7 ) S
JAW_ Lab Cert!# .Z
or analysis:
Date submitted ?L.27/d/
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR �` /
CpS�AMPLLE�PERRIIO,D ❑Jan -June my -Dec
REG C G TO CLASS Monthly'
❑ORW rout l
� ❑HQW ❑Trout ❑PNA
JUL 2 6 2021 ❑zero -flow ❑water Supply [:]SA
FILES ❑Other
CEI� i'I"tAl.
DWR SECTION PLEASE REMEiViSER TO SIGN ON THE REVERSE v
❑ No discharge this period'
Outfa 1
No.
Benchmark
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
50 or 100 see permit
pH,
Standard units
Within 6.0 — 9.0
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
1S
New Motor Oil Usage,
Annual average gal/mo
7
rv�,
S
aoo e.
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
Outfall
No.
Permit Limi4
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
15
Total Suspended Solids,
mg/L
50 or 200 see permit
pH,
Standard units
6.0 — 9.0
} For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250
last revised O 'ler 25, 2012

n
/'\
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: http://12ortal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
Permit No.: N/C/01 /8/d/0/fl /C�/ Cb/ or Certificate of Coverage No.: N/C/N/D /g/ L} 7/%/ �/
Facility Nam /L od4c.c.
County: Pvi Phone No.
�U �� "
Inspector:
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): " 5-'"
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
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
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
{ permitted site outfall. The previous measurable storm event must have 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.
By thY'signa9dreX, 91tiV)6t this report is accurate and complete to the best of my knowledge:
of Permittee or Designee)
L 000
SWU-242, Last modified 10/25/2012
Page 1 of 2

1. Outfall D scription: C.l-
Outfall No. _I Structure (pipe, ditch, etc.) (�^
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using sic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L16 V 6A&wn / . Gle,•r
3. Odor: Describe any distinct odors that t
weak chlorine odor, etc.):
may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 n 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:
\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 is extremely muddy:
O 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes / Nd
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? es (N)o
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.
rZI
Page 2 of 2
SWU-242, Last modified 10/25/2012

1. Outfall D scription: / 7'
Outfall No. _ �_ Structure (pipe, ditch, etc.) (/
❑n ,ina C"mm-
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using b sic colors (red, brown, b)ue, etc.) and tint
(light, medium, dark) as descriptors: 7T '42, er
3. Odor: Describe any distinct odors that the
weak chlorine odor, etc.): a
may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 <2) 3 4 5
S. 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:
\=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 is extremely muddy:
(9 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes / N�
a. Is there an oil sheen in the stormwater discharge? Yes l No
9. Is there evidence of erosion or deposition at the outfall? Yes CN
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
SWU-242, Last modified 10/25/2012