NCG080661 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. fIcGols� SAMPLE COLLECTION YEAR
FACILITY NAME w 6 L\ C- SI—X01—C-6-5 SAMPLE PERIOD ❑ Jan -June July -Dec
COUNTY ► moi(,or ❑ Monthly' (month!
PERSON COLLECTING SAMPLES Lab Cer t -fl t3 N DISCHARGING TO CLASS ❑ORW DHQW QTrout �PNA
LABORATORY_ �d+C_� Lab Cert. # l 2�(-ORECEIVE[) E]Zero-flow [Water Supply OSA
Comments on sample collection or analysis: L?lther
OCT 26 2015
PLEASE REMEMBER TO SIGN ON THE REVERSE 4Part A: Vehicle Maintenance Areas Monitoring Requirements CENTRAL FILES
DI/VR SECTION Cj No discharge this period'
Outfall DateX
00530 00400
No. Sample ColSuspended H 00556
mo dd p J Non -Polar Oil and Grease/TPH EPA New Motor Oil Usage,/ ds, mg/L Standard units Method 1664 (SGT -HEM), mg/LAnnual average gal/mo
Benchmark -0 see permit Within 6.0 — 9.0®�) 1— Nv 2 ® ►►,� o
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? /'yes
(if yes, report your analytical results in the table immediately below) no
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall Date 00556
0400
No. Sample Collected, Non -Polar Oil and Grease/TPH EPA Method Total Suspended Solids, 00530 ®PH,
Jo/
dd/yr 1664 (SGT -HEM), mg/L pH'
Permit Limit _ 15 mg/L Standard units
50 or 100 see permit 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
S W U-25 0
last reN, ised October 25. 3013
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STORM EVENT CHARACTERISTICS:
Date 9 �d1 1 first event sampled)
Total Event Precipitation (inches): __ [.11
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 Z 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 ❑ T []
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F-1NOREGIONAL OFFICE CONTACT NAME -
Mail an original and one copv of this DMR includin all "No Dischar e" re orts within 30 da s o recei t nf the lab results or at endo monitorin eriod 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 �signyficanr/,penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
,� ���� /
(Date)
Additional copies of this form may be downloaded at: littP.//Portal.ncdenr,ocg/web/wq/ws/su/--iipdessw#tab-4
S W LI -250
last revised October 25. 2012
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