NCG080771 DMR SW (2)

Sergi -annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted 1 I � �
CERTIFICATE OF COVERAGE NO. NCG08_D2 2 L
FACILITY NAME
COUNTY �`-- ✓ —T
PERSON COLLECTING SAMPLES c»1n✓) 7r, `f'
LABORATORY Pe--,r-c) Lab Cert. # "3(21Q) ",zp
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR �� I
SAMPLE PERIOD ❑ Jan -June ,4 July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
—��
[]Zero -flow ❑Water Supply [:]SA
[–]Other
JAN 2 7 2015 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CERTF,I L FILES ❑ No discharge this period'
DVJR SZCTiON
Outfall Date
No. Sample Collected,
mo/dd/yr
00530
00400
00556
pH,
Standard units
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT -HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark -
50 or 100 see permit
Within 6.0 – 9.0
15
-
-�. 7
'Z . l-oAf
4500
5g3.ao
I �- I �► I I
e S. 0-0
. a
I a- I �►I I't I
--Mo
c 5. -73
S
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 Date
No. Sample Collected,
mo/dd/yr
00556 00530
00400
Non -Polar Oil and Grease/TPH EPA Method Total Suspended Solids,
1664 (SGT=HEM), mg/L mg/L
pH,
Standard units
Permit Limit -
15 50 or 100 see permit
6.0-9.0
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 revised October 25, 2012
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 0-l':'t y(first event sampled)
Total Event Precipitation (inches): l
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 INA 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 oriainal 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 o "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 in 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."
ln�
(Signature of
A�
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
t
SWU-250
last revised October 25, 2012
Page 2 of 2