NCG080661 DMR SW (2)

Serpi -annual Storrmwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted (o - 1 -S;'- I
CERTIFICATE OF COVERAGE NO.
FACILITY NAMEt` S�tZvIL�� RFs NAY► 1(�
COUNTY 1 4C
PERSON COLLECTING SAMPLES �� r!j � � �q p a rj
LABORATORY PA -C-9 Lab Cert. # 4-0 , l -z-
Comments
Comments on sample collection or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
SAMPLE COLLECTION YEAR Z 0 )
SAMPLE PERIODJan-June ❑ July -Dec
or []Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout OPNA
❑Zero -flow ❑Water Supply E]SA
IV E D ['Other_ 3
JUN 2 2, 2015 PLEASE REMEMBER TO SIGN ON THE REVERSE ~�
CENTRAL FILES C No discharge this period'
DWR SECTION
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
Total Suspended
Solids, mg/L
pH,
Standard units
Benchmark
F i
-
o` -a 2_,
50 or 100 see permit
5
Within 6.0 - 9.0
L, r�
F2
O
a
00556
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT -HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
15
0 n-, o
N
U o
D
?i0 �►�
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? V�e's 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.
Permit Limit
Date 00556
Sample Collected, Non -Polar Oil and Grease/TPH EPA Method
mo/dd/yr 1664 (SGT -HEM), me/L
15
00530 • D0400
Total Suspended Solids, pH,
mg/L Standard units
50 or 100 see permit 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.
S W U-350
last reN ised October 35. 20 12
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STORM EVENT CHARACTERISTICS:
i
Date Nfirst event sampled)
Total Event Precipitation (inches): j,30
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
(Vote: 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 AND PART B MONITORING RESULTS:
o A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE 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 ATANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME -
Mail an original and one copy of this DMR including all "No Discharge" reports within 30 dais of receipt of the lab results (or at end of monitor�na Herrod �n
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 ano imprisonment for knowing violations "
0
(Signature of Permittee)
- /,P- /5 -
(Date) 5 -(Date)
Additional copies of this form may be downloaded at: I)ttg://Portal.ncden.r.org/webLwglws/su/-tlpdessw#tab-4
SWU-250
last revised October 25. 2012
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