NCG080819 DMR SW

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG08 O 8 / q
FACILITY NAME fS/SCa
COUNTY
PERSON COLLECTING SAMPLES ZAk' o X/�len
LABORATORY 141Co (14c Lab Cert. # I
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
Outfall Date 00530 00400
No. Sample Collected, Total Suspended pH,
mo/dd/yr Solids, mg/L Standard units
Benchmark - 50 or 100 see permit Within 6.0 — 9.0
l .22. 0 7, 2
SAMPLE COLLECTION YEAR 2 O /
SAMPLE PERIOD N Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [:]SA
RECEIi/En ❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE
JUL 13 2015
CENTRAL FILES
DWR SECTION
00556
Non -Polar Oil and Grease/TPH EPA
Method 1664ISGT-HEM1. me/L
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Kyes _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 Date 00556
No. Sample Collected, Non -Polar Oil and Grease/TPH EPA Method
mo/dd/yr 1664(SGT-HEM). ma/L
Permit Limit I -
15
00530
Total Suspended Solids,
50 or 100 see
z2, o
❑ No discharge this period'
New Motor Oil Usage,
Annual average sal/mo
f
00400
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 October 25, 2012
Page] of 2

STORM EVENT CHARACTERISTICS:
Date (first event sampled) /
Total Event Precipitation (inches): n G
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 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 II SECTION B.
• 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 REGIONAL OFFICE? 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 at end of monitoring period in
the case of "No 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 -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."
(Signature of Permitt5
(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 O, r 25, 201,2
rage 2 of 2

OMICROBAC,°
Fayetteville Division
Certificate of Analysis
Sysco Foods Raleigh, LLC Date Reported: 05/21/15
Mr. Zak Lokken Project: Storm water sample - Semiannual Date Received: 05/14/15
1032 Baugh Road Date Sampled: 05/12/15
Selma NC, 27576 Sampled By: Lokken
Stormwater, grab
K5E0490-01
Analyte Result Units Analyzed Analyzed By Method Qualifier
Field Data
pH 7.2 pH Units 05/12/15 06:45 Lokken pH
Analyzed by: Microbac Laboratories, Inc. - Fayetteville
Oil & Grease (HEM) <5.00 mg/L 05/20/15 09:30 AFO EPA 1664 Rev. B
Total Suspended Solids <1.00 mg/L 05/15/15 14:30 MLW SM 2540 D-1997
QC Batch Run - (Microbac Laboratories, Inc. - Fayetteville)
Analyte Result Units Source RPD Limit
Total Suspended Solids 22.0 mg/L K5E0493 115 5
Total Suspended Solids
State Certifications:
NCDNR # I 1
NCDOH #37714
92.0 mg/L
K5E0445 0
Respectfully Submitted
Jeanne Overstreet, Project Manager
Thank you for your business. We invite your feedback on our level of service to you. Please contact the Division Manager, Rob Dermer at 910-864-1920 with any
c1uestions. You may also contact J. Trevor Boyce, President at prestdem a microbac com
Microbac Laboratories, Inc. Page 1 of 2
2592 Hope Mills Road I Fayetteville, NC 28306 1910.864.1920 p 1910.864.8774 f I www.microbac.com