NCG080161_DMR_20210823

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted 71i7nR 7_02a
CERTIFICATE OF COVERAGE NO. NCGO8 O t U \
FACILITY NAME [F' - - ,X,.
COUNTY RJv.+..� tic}'ear..vv.e ^�
PERSON COLLECTING SAMPLESu1~.m
LABORATORY `�65a Lab Cert. It Lm 6
Comments on sample collection or analysis:
�r►r.fXQ C_\Cx*�_ q aj `i i, Csk" S\ G4� S�c.eaz
SAMPLE COLLECTION YEAR o-?Oa1
SAMPLE PERIOD ®Jan -June ❑July -Dec
or ❑ Monthly` /month)
DISCHARGING TO CLASS ❑ORW ❑HQW [-]Trout ❑PNA
❑Zero -Row ❑Water supply ❑SA
[�&Other�m.
PLEASE REMEMBER TO SIGN ON THE REVERSE 3
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes )Cno
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (if applicable)
REC
❑ No discharge Ay4PrISd2021
i-T -ILEa
TION
Outfall
No.
Date
Sample Collected,
rno/dd/yr
00530
00400 00556
Total Suspended
Solids, m L
pH, Non -Polar Oil and Grease/TPH EPA
Standard units Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average al/mo
Benchmark
-
S0 or 100 see permit
Within 6.0-9.0 15
-
t
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfail Date
No. 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 Lima -
15
50 or 100 see permit
6.0- 9.0
{
%,off.
�r
i 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 rcviscd April 11, 2013
Page 1 of

STORM EVENT CHARACTERISTICS:
Date ob o3 s°first event sampled) i rr
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 1, or Tier 3 4sponses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART it SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY QNE OUTFALL? YES Q NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
the case of "Na Discharge" reports) to:
Division of water Quality
Attn: DWQ 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 supervisio
that qualified personnel properly gather and evaluate the information submitted. Based an my Inquiry of the person or
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief
there are significant penalties for submitting false information, including the possibility of fines and imprisonment for kr
JO caNk.� a.3 oa i
(Signature of Permittee) 0(Date)
Additional copies of this form may be downloaded at:
in accordance with a system designed to assure
rersons who manage the system, or those persons
true, accurate, and complete. I am aware that
)wing violations."
S W U-250 last rcviscd April 11, 2013
Page 2 of 2