NCG080587 DMR SW

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted M.V) A 1 6615
C%�I$w
=� SAMPLE COLLECTION YEAR
CERTIFICATE OF COVERAGE NO.
SAMPLE PERIOD Fj Jan -lune July -Dec
FACILITY NAME `
COUNTY � or ❑ Monthly lmortthl
PERSON COLLECTING SAMPLES DISCHARGING TO CLASS UORW ❑HQW ❑Trout [PNA
LABORATORY
Lab Cert. #
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
Zero -flow ❑Water Supply L_jSA
RECEIVEMENR/ W ❑Other
JAN 2 2, 2010 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Wafer Quaiil~y Regional
Operations Section
�°`` No discharge this period
Outfall
"Na.r.-
Date
Sample,Collected,
mo%dd%yr
00530'
00400 00556
00400
Total Suspended
Solids, mg/L
pH, Non -Polar Oil and Grease/TPH EPA
Standard units Method 16641(SGT=HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark-;,�
-
50 -or 100 see permit
Within,6:0– 9.0 15
-
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of neer 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,
No.
Date
Sample Collected,,
mo/dd/yr
00556
00530
00400
Non-Pdla"r Oil and, Grease/TPH`EPA Method
16%4 (SGT=HEM); mg/L
Total Suspended Solids,
mg/L
pH,
Standarci'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.
SS1Vi]-25{1 last revised October 25.2012

STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches):
Date (list each additional event sampled this reporting period, and rainfall amount)
0 Total Event Precipitation (inches):
h"1 0) +
Note: IIf you report a sample value in excess of the benchmark, you must implement Tier �, 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 11 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
EI
REGIONAL OFFICE CONTACT NAME:
Mail an_orr'ginal and one copy of this DMR including all "No Discharge" reports within 30 dans of receipt of the lab results for at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQCentral Files
1617 Mail Service Center
q 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 penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
(Date)
Additional copies of this form may be downloaded at: htt •//aortal ncd mr.org/web L\vq/ws su/nodessw4tab-4
i?st revised October -2 5, 2012
SWLJ_250 Page 2 of 2