NCG080134 DMR SW (2)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality eneral Permit No. NCGO80000
Date submitted D�
CERTIFICATE OFC V
FACILITY NAME
COUNTY
PERSON COLLECTX4G
LABORATORY f".�V RG;K--L7-`n
Comments on sample cpllection or ana
SAMPLE COLLECTION YEAR
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly" (month)
DISCHARGING TO CLASS KORW ❑HQW []Trout ❑PNA
C - Zero -flow ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO $IGN ON THE REVERSE
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_ yes _U- o
(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 Date
No. Sample Collected,
mo/dd/yr
00530
00400
00556
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT -HEM), mg/L
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
-
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Station. and Terminals (If applicable)
Outfall 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 Limit I I IC1115
50 or 100 see permit
6.0 -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 April 11, 2013
Page I of 2

STORM EVENT CHA(R�ACT STICS:
Date `!' J(irst event sampled) 5JR1e,5
Total Event Precipitation (inches): a
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 ANY ONE 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 Discharae" reoorts, within 30 days of receipt of the lab results for at end of monitoring period in
the case of "No Discharae"'reoorts) 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 penaltie'A for submitting false information, including the possibility of fines a -id imprisonment for knowing violations "
(Date)
Additional copies of this form may be downloaded at: Iltt .; Lrtal.rucienr.or `web wq/wS/Su/npdessw#tab-,1
SWU-250 last revised April 11, 2013
Page 2 of 2