NCG080057 DMR SW (3)

Semi-annual Stormwatelr Discharge Monitoring -Report
for North Carolina Division of Water Qual.Ity General Permit No. NCG080000
Date submitted % r-.
o i
CERTIFICATE OF COVERAGE NO.
FACILITY NAME—
COUNTY J //
PERSON COLLECTING SAMPLES,
LABORATORY Lab Cert. #
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR g1 16—
SAMPLE PERIOD N, Jan -June [� July -Dec
or [j Monthlyl (month)
DISCHARGING TO CLASS ❑ORM [DHQW []Trout OPNA
RECEIVED ❑Zero -flow OWaterSupply OSA
OOther
AUG 0 3 2015
CENTRAL FILES PLEASE REMIiENP2ER 51G, CWT T:1E REVERSE >
DWR SECTION 0 lVo discnarge this period'
Outfall Date
No. Sample Collected,
mo/dd/yr
Benchmark -
00530
00400
00556
Nem Motor Oil Usage,
Annual average gal/mo
Total Suspended
Solids, mg/L
50 or 100 see permit
pH,
Standard units
Within 6.0 — 9.0
Non -Polar Oil and GreasW/TPH EPA
Method 1664 (SGT -HEM), mg/L
15
_
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/rater Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall Date 00556 00530
No. Sample Collected, Non -Polar Oil and Grease/TPH EPA Method Total Suspended Solids,
mo/dd/yr 1664 (SGT -HEM), mg/L mg/L
Permit Limit - 15 50 or 100 see permit
00400
pH,
Standard units
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.
SWU-250
last revised October 25, 2012

STQRilll EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches): _
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:
o A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
O 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER Ta.R REQUIREMENTS. SEE PERMIT PART I! SECTION B.
® TIER 3: HAS YOUR FACILITY HAD 4 OR MORE,BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY CNE OUTFALL? YDS ❑IVO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
PAcil or original and one coov of this DMR including all "iso Discharae" fecorts within 30 days 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: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN T H!S CER T iFICATiON FOR ANY IN=ORMAT!ON 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."
Perm
(DAte)/
Additional copies of this form may be downloaded at: http://Dortal..-icdenr.org/web/wq/­ws/su/nDdesswtttab-4
SWU-250
last revised October 25, 2012
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