NCG080799 DMR SW (2)

Semi-annual Stormwater Discharee Monitoring Report
for North Carolina Division of Water Qali y General Permit No. NCGO80000
Date submitted 7po2 115
CERTIFICATE OF COVERAGE NOg1N'C� - ' a SAMPLE COLLECTION YEAR 20(5
FACILITY NAME 14'4 k McJAA 1{NNic7ipa7—ou_4tio;s Ce u SAMPLE PERIOD WrJan-June ❑ July -Dec
COUNTY Gtfil-ford or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES GlY Nardin9 DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY (�efi�cclti Lab Cert. it l(05 ❑❑Zero -flow [��Alater Supply OSA
C�otmmlentls�on sample collection or analysis: / Other
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�— PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallbUa hn%J m1otor oil per month? • yes _no
(if yes, report your analytical results in the table immediately below) CENTRAL FILES
DWR SECTION
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable) gNo discharge this period'
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1 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 _ (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:
• 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 ❑ NO [�
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES F-1 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
thatliqualified 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."
Permittee)
_% d,;-a/S
(Date)
Additional copies of this form may be downloaded at: http://Portai.ncdenr.org/web/wg/ws/su/npdessw#tab-4
SWU-250 last revised April 11, 2013
Page 2 of 2