NCG080161 DMR SW (2)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG,0 _QS
FACILITY NAME C - ham•
COUNTY tl,)
PERSON COLLECTING SAMPLES ,__KC
LABORATORLab Cert. t# 53yZ.
Comments on sample collection or analysis:
iLL . , A.. x . e" �, np CA n' i 6a�
SAMPLE COLLECTION YEAR Zo\S
SAMPLE PERIOD ❑ Jan -June M July -Dec
or ❑ Monthly' (monthl
&tLlSIV GCLASS ❑ORW ❑HQW ❑Trout ❑PNA
�� �� ❑Zero -flow ❑Water Su ly ❑SA
AUG 2 6 20115other o �PO.r `
T C� CENTRAL FILMEASE REMEMBER TO SIGN ON THE REVERSE
DWR SECTION
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 A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall = = Date
No. = =,- Sarriple Collected,
_-�Nmo/dd/yr
00530
0.0400 , _ _
00556. -
_-
Total`Suspended �,
_ -Solids; mg/L , ;.'
°'s - = pH, ; ,_ ; -,
;, - Standardpunits"
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 perriiit=
-Withid 6:0`=9.0
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall."00556
`-: No. - :Sainple,Collected,,
-- rrio/dd/yr
- -" -
_ - " 00530 _ r
00400-"
Nod-Polari�il;and Grease/TPH"EPA Method
9:664 (SGT -HEM), mg/L=�
Total Suspended Solids, :_ `
mgJL "
pH,
-Sia6dard units'
Permit Limit _
� - -15
- 50 or 100 see -permit
�b.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.
SWU-250 last revised April 11, 2013
Page 1 of 2

STORM EVENT CHARACTERISTICS:
8O3SlyDate \5 (first event sampled)
Total Event Precipitation (inches): 3®\'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 AAND 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 FIND ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal 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 penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
S ,al Ly
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250 last revised April 11, 2013
Page 2 of 2