NCG080696 DMR SW (5)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 9 '2- 9- aoJ�
CERTIFICATE OF COVERAGE NO. NC 08 _
FACILITY NAME —1.-,n o 1 Zcl, tilun
COUNTY
PERSON COLLECTING SAMPLES
LABORATORY -e- Lab Cert. # la
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR (901 -5 -
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or ® Monthly'(month)
'� JCiARGING TO CLASS 0ORW ❑HQW Trout ❑PNA
i/ Zero -flow ❑Water Supply OSA
va 12 2015 ❑Other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DMR SECTION
[] No discharge this period'
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month r _yes
(if yes, report your analytical results in the table immediately below)
._.._a,... c-.,,.,+- nnrl Sacnndary Containment Areas at Petroleum Bulk Stations and Terminals
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
I- 25 2012
SWU-250
last revised Octo er
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 1-a3 -!S- (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 ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Marl 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 penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
/-aur.2
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/­ws/­su/npdessw#tab-4
last revised October 25, 2012
SWU-250 Page 2 of 2