NCG080674 DMR SW

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Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted la) 2 4 1.10 15V
CERTIFICATE OF COVERAGE NO. NCG08 O 6 7 L
FACILITY NAME G -e yvtr�L de r./ tcc-1 Cex,d,nk M-k;t4 . F,•c,147
COUNTY lN
PERSON COLLECTING SAMPLES _ CYu►da S Cavvzrl
LABORATORY Pa cc, , Cr. C. p,,,, Zc. Lab Cert. # O 4 0 , 519 0
Comments on sample collection or analysis:
RECEM Y ED
JAN 0 8 2015
CENTRAL FILES
SAMPLE COLLECTION YEAR 1201 K DWR SECTION
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply EISA
®Other Nd kJ
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Y/yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556 "
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT -HEM), mgJL
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
=
coo 1
1 1 a oci -t
a. 0
S
< 5"o
S-
00 a
L ia 01 l `t
2"X 0 1
15, 4 7
<,5-, O
003
1 Laiok y
10 0
6,40 -
X5.0
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT -HEM), mgJL
Total Suspended Solids,
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 April 11, 2013
Pagel of 2

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4
STORM EVENT CHARACTERISTICS:
Date 14RIt4 (first event sampled)
Total Event Precipitation (inches): 1:
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 it SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO Z
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
t�w��a��r{- P� lcuzl� ar<- be,�nS vhu..�'�++`�:1 w�.•.i-h� wh�cl.ha �{�no-,w� l
tic. �v�IS �)v.� d1x. bcv►cL� wwYl� � 6. Off# k«�I-J,
-._J ___ __�__ _!al_!_ www _�___�.__ __ __.. ii.._ _ _._ _ _ _ii ___ _ _ ..• . �� . w . _. . . _ - _
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 f law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified person I operly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible or hering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are significan Ities for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
/- S- /'-
(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 April 11, 2013
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