NCG080799 DMR SW

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Qali y General Permit No. NCG080000
Date submitted — I ) 10
CERTIFICATE OF COVERAGE NCGO$ O SAMPLE COLLECTION YEAR
FACILITY NAME R'� �1- l r Kmtc- '� C44u SAMPLE PERIOD ❑ Jan -June [DJuly-Dec
COUNTY Cu -t kWr4 __ ee
C��r- or ❑ Monthly' (month)
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PERSON COLLECTING SAMPLES 4g14!+'�AR GTO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY Lab Cert. tt 0-5 JAN' 2Q16 ❑Zero -flow [�IVater Supply EISA
Comments on sample collection or analysis: CCh1T [:]Other
DWR �GTION", � PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did thil facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? A/ _no
(if yes, report your an results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
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Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals'(If applicable)
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
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date A2-61 19(first event sampled)
Total Event F recipitatlon (inches): 14 -
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 ATTHE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
O 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 Discharge" reports within 30 days of receipt of the lab results (or 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, 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_pena�ies for submitti alse information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
_! li t,
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/wej2LEqL%qs/su/npdessw#tab-4,
SWU-250
last revised April 11, 2013
Page 2 of 2