NCG070006 DMR SW

North Carolina Division of Water Quality
SEMI-ANNUAL STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT
Vehicle Maintenance Activities Only
Date submitted _ //!jhs
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CERTIFICATE OF COVERAGE NO. NCG 0 1 p _e X6 SAMPLE COLLECTION YEAR ,20 l `1
FACILITY NAME ,4R✓an*tl �1v�orck�
COUNTY 1`ildwzt r
PERSON COLLECTING SAMPLES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
LABORATORY Lab Cert. #
Vehicle Maintenance Area (VMA) Stormwater Monitoring Results: Only for facilities using an average of > 55 gal of new motor oil per month.
Total event rainfall' or ❑ No discharge this periodz
Outfall No.
C t
Sample
Collected,
mm/dd/yr
Total Suspended
Solids (TSS), mg/L
Non -polar O&G/TPH, mg/L
(Method 1664 SGT -HEM)
(if applicable)
Oil and Grease, mg/L
(If applicable),
pH, -Standard units New Motor Oil Usage,
(if applicable) Annual average gal/mo
Benchmark-
100 or 503is.
Within 6.0 — 9.0 -
-30.
0
IAN ]a 205
Th I
CENTRAL FIL S
ota precipitation must be recorded using data from an on-site rain gauge. O
2 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
3See General Permit text that identifies the especially sensitive receiving water classifications where the more protective TSS benchmark applies.
*FOR 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 ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
SWU-254 Vehicle Maintenance Activities DMR Last Revised:.Clay 17, 2013
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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, NC 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."
Permittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw
SWU-254 Vehicle Maintenance Activities DMR
Last Revised: May 17, 2013
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